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BOSTOhl
Medical Library
8 The Fenway
Vol. VIII No. i
The Journal of
Mental Pathology
Subscription Price: — ^$2.50 per volume. Single Copies, 50 cents.
Edited by Louise G. Robinovitch, B. ^s L., M.D.
(EMtortal Boaxb
Dr. V. MAGNAN, Dr. A. JOFFROY, Dr. F. RAYMOND (Paris), Dr. CHAS. K.
MILLS (Phila,), Dr. G. MINGAZZINI, Dr. SANTE DE SANCTIS, Prof, L.
LUCIANI (Rome), Dr. JUL MOREL (Belgium), Dr. E. REGIS (Bordeaux).
Contributors' Staff
BALLET, Prof. G. (Paris) ; BLEULER, Prof. E. (Zurich) ; BOURNEVILLE,
Ed. Progris MSdical; CANNIEU, Prof. (Bordeaux) : CERLETTI, Dr. Ugo (Rome) ;
CHATTERJI, J. C. (Benares, India); CLAPAREDE, Ed, Arch, de Psychology
(Switzerland); DAGONET, Dr. (France); DUCCESCHI, Dr. V. (Rome);
FABRIZI, Dr. G. (Rome); FAREZ, Dr. Paul; FERRI, Pro^ E. (Rome);
GIANNELLI, Dr. A. (Rome) ; GUIDI, Dr. G. (Rome) ; LOURIE, Ossip, Ph. D.
(Paris); MARIE, Dr. A. (France); MARRO, Dir, Annali di Freniatria (Italy);
MORSELLI, Prof. E. (Italy) ; PERUSINI, Dr. G. (Rome) ; PifeRON, Dr. H. (Paris) ;
POLIMANTI, Dr. Osv. (Rome) ; RITTI, Dr. Ant., Ed. Annates Medico-Psychologiques;
SEMIDALOW, Dr. B. (Moscow); SERGI, Prof. G.; SERGI, Dr. S. (Rome);
SERBSKI, Prof V. P. (Moscow) ; SOUKHANOFF, Dr. S. (Moscow) ; TOULOUSE,
Dr., Ed. Revue de Psychiatrie; TSCHISCH, Prof. W. (Russia) ; VURPAS, Dr. CI.
(France); VASCHIDE, N. (Paris).
STATE PRESS, Publishers,
NEW YORK, N. Y.
MSS. AND Communications should be Addressed to the Editor,
28 West I26th Street, New York.
TABLE OF CONTENTS.
LEADING ARTICLES.
The Helweg-Westphal Tract, etc., Dr. A, Giannelli i
A Case of Hysteria Simulating the Syndrome of Brown-
Sequard, Dr» Pietro Timpano 9
Physiologic Effects Following Successive Ablation of one
Frontal Lobe and one Cerebellar Hemisphere, Prof, Min-
gazzini and Dr, Polimanti, I4
The Genesis of Sex, Dr, Louise Rohinovitch. 16
TRANSLATIONS AND ABSTRACTS OF CURRENT LITERATURE.
A Medal for Dr. Magnan 31
Hygiene in the Russian Prisons 31
Meningo-encephalitic idiocy 37
A Case of Acromegaly 38
A Case of Attack by Habit , 38
Forms of Dementia Precox 38
The Paris Population 39
Criminality m England 39
Decreasing number of Medical Students here and in Europe. . 39
Effect of bearing of the Young upon the Body Weight, etc.. . 40
Eschars in General Paralysis 40
Speech Training as a Factor in Development of Feeble Minded 40
Infanticide. Anatomical and Clinical Contribution 40
Two Years of Family Patronage of the Insane, Kherson .... 41
Cerebral Hereditary Syphilis 41
Lombroso's Jubilee 41
BOOK REVIEWS.
La Question Sexuelle Exposee aux Adultes Cultives, Prof.
A, Forel 41
Die Simulation von Geisteskrankheit. Mit einem Anhang
die Geisteskrankheit in den Gefaengnissen, Prof. P, Penta 43
L*Ame et le systeme nerveux. Hygiene et Pathologie, A,
Forel 44
Experimentation sur le prophylaxie de la syphilis. These
de Paris, 1906, Dr. Paul Maisonneuve 45
Christianity and Sex Problems, Hugh Northcote, M,A 46
The Subconscious, Prof. Joseph Jastrow 46
Contribution a I'etude de la necrophilie. Uaffaire Ardisson.
Drs. Michel Belletrud and Edmond Mercier. 46
Gehirn and Ruekenmark. Leitfaden fuer das Studium der
Morphologic und der Faserverlaufs, etc., Dr. Emil
Villiger 47
Die Leukocyten als Parasiten der Wirbeltiere. Ein Beitrag
zur wissenschaftlichen Weltanschauung, etc. Dr.
Johannes Haedicke 47
Enigmas of Psychical Research. James H. Hyslop 48
Lectures on Clinical Psychiatry, Emil Kraepelin 48
Affektivitaet, Suggestibilitaet, Paranoia, Prof. Bleuler 48
Primer of PsychoIog>^ and Mental Diseases, Dr. Burr 48
Books and pamphlets received . 3d cover
The Journal of Mental Pathology
Vol. VIII 1906. No. i
THE HELWEG-WESTPHAL TRACT.
(Dreikantenbahn — OUvenhundel — Fasciculus periolivarius —
Fasciculus circumolivarius) .
By Dr. A. Giannelli^ Docent University of Rome, Italy, Chief
Fasciculus circumolivarius).
Our knowledge on the triangular tract of Helweg is as yet
incomplete, particularly so as regards its proximal and distal
relations with the surrounding structures ; much less do we know
about its function.
Helweg claims that the irregular tract that bears his name
can be found in the insane only, in whom the area corresponding
to this tract is easily distinguished by the smallness of its ner-
vous fibres, which is due to congenital defect. Other authors
also found that those fibres were thin and rarified, and on that
account speak of more or less accentuated degeneration of Hel-
weg's tract, — without having found any actual degeneration in
their cases.
Obersteiner, who has published the best description and topo-
graphic relations of Helweg's triangle (according to horizontal
sections), justly remarks that the distinctness with which this
triangle appears is far more variable than is either its form or
relation to its surrounding areas. Sometimes this triangle ap-
pears so distinctly that it is readily differentiated from the adjoin-
ing areas; under such circumstances it is interpreted as being in
a condition of marked degeneration, such as it is found to be
in the posterior columns during the course of tabes of medium
intensity.
An examination of a series of normal and pathologic spinal
cords makes me accept Obersteiner's opinion that it is highly
improbable (in hohem grade unwahrscheinlich) that a clearly
2 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
apparent zone of Helweg should, even when showing rarifica-
tion of its fibres, necessarily indicate that it presents pathologic
alterations.
The fibres in Helweg's triangle are especially characterized by
thinness of their myelin sheath; this trait is of interest particu-
larly because it presents individual variabilities. For this reason
my analysis of those published papers on Helweg's triangle, which
I have examined, makes me think that the authors treated of the
more or less marked distinctness of the triangle rather than of
true degeneration, the latter being of more rare occurrence than
is generally admitted. Hence the importance of the study when
there is true and complete degeneration of Helweg's triangle, as
such a study makes it possible to follow its exact course as well
as its relations with the surrounding areas.
Recently I have had occasion to examine the medulla oblongata
of an idiot with agenesia of the ocular globes and atrophy of
some tracts of the olfactory nervous system. Unfortunately,
serial sections of the spinal cord could not be made. Horizontal
sections, at the level of the beginning of the distal end of the pyra-
midal decussation, show an area of degeneration in the lateral
columns ; this area is of an irregular triangular shape and situated
at the periphery of the lateral columns ; the anterior angle is
rounded and runs into the anterior radicular fibres that emerge
laterally from the anterior horn (fig. i, a).
Within and behind the described area of degeneration is seen
a markedly rarified zone separated from the central gray matter
by a thin band of normal fibres in front of the pyramidal tract
of the lateral column. Its form on the surface of the section
is almost circular (fig. i, ^).
In the triangular area the degeneration is complete; peripher-
ally are seen some very small fibres; in the circular area there
is, on the contrary, highly marked rarification of the fibres, and
there is no distinct line of demarkation between the degenerated
and normal tissue.
The respective positions of the two described zones are main-
tained throughout the course of the pyramidal decussation. These
positions change at the end of the decussation, where the oliva
accessoria medialis begins: here the triangular area is situated
externally to the external end of the oliva accessoria medialis, —
back of the most lateral part of the pyramidal tract (fig. 2, a).
Just behind the triangular area is situated the rarified area, the
shaj)e of which is here more rounded (fig. 2, &). Between the two
is always seen a thin layer of normal fibres.
At the point of complete decussation of the sensory tracts.
THE JOURNAL OF MENTAL PATIfOLOGY, Vol. VIIL, No. i, 1906.
Jb
-d
Fig. I. Section of the cervi- Fig-, 2. Section of the nie-
cal spinal cord a Httle before the duUa oblongata at the level of
pyramidal decussation; a, Flel- the beginning of decussation of
weg's area ; b, the round, rari- the sensory tracts ; a, Helweg's
fied zone.
area; &,the round, rarified zone.
'J'S^'^im^m^,^
Fig. 3. Section of the medulla oblongata at the level of the
most distal part of the bulbar olive. The section is somewhat
oblique, the left side being at a lower level than the right; a, on
the left side, Helweg's area, appearing at first as a circle, then as a
semi-circle, a.i, on the right side, containing the beginning {c) of
the bulbar olive.
THE HGl.WEG-WESTPHAL TRACT~Dr. Giannei.li. 3
and before any trace of the oliva inferior is seen, the completely
degenerated triangular area is essentially changed in form. At
first it is seen as a small circle containing an area of normal
fibres, (fig. 3, a) ; immediately afterward it takes on the shape of
a semi-circle parting from the external end of the oliva accessoria
medialis, its convexity being turned forward and outward;
the other end is turned backward and inward (fig.
3, a i). The semi-circle is visible even with the naked eye; it
embraces a complexus of normal fibres, in the middle of which
appears the most distal part of the oliva inferior (fig. 3, c),
which, in its turn, spreads out gradually in a manner similar
to that seen in sections of the proximal end, always remaining
limited anterolatero-posteriorly by the degenerated semi-circle.
With the appearance of the oliva inferior the posterior de-
generated zone is pushed backward and it presses against the
ascending (descending) root of the fifth nerve.
The semi-circular degenerated area is limited externally by
from the lateral end of the oliva medialis: at first it is directed
forward and outward, then turns abruptly backward and inward
ending about the middle of the dorsal leaflet of the oliva bulbaris.
The semi-circular degenerated area is limited externally by
segments of coarse fibres, directed obliquely, all being turned
in the direction of the centre of the plane circumscribed by
the degenerated area; besides, that portion of the area which
is situated at the periphery of the medulla is also limited by
the superficial ventral arciform fibres. Along the inner side of
the semi-circiilar area there are tufts of fibres of the olivo-cere-
bellar system; these present themselves at first (distally) only
in the dorsal part of the inner side of the degenerated area, then
turn abruptly ventrally also.
With the increase of the bulbar olive the fasciculus circumoli-
varius becomes thinner, while its curve embracing the olive be-
comes larger. Besides, like in the upper planes of the olive,
there are, within the degenerated area, transverse sections of
fibres of a limited number at first, then of large calibre, but which
become more abundant later. In the proximal part of the olive
these fibres run closer and closer together until the semi-circular
area becomes completely effaced.
In its proximal end Helweg's tract has the shape of a groove,
appearing in horizontal sections as a semi-circle embracing the
external part of the bulbar olive. For the reason of this topogra-
phy it should be termed fasciculus circumolivarious. Its gradual
disappearance as it mounts proximally indicates that its fibres
are in relation with the cells of the olivary leaflet itself.
4 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
The bulbar olive does not present any alterations; the cells of
its leaflet are normal and distinct, as are those of the oliva
medialis and dorsalis.
This finding shows that the triangular tract ends in the olivary
body and does not extend directly into the cerebrum, as Helweg
claimed it did. What Helweg has described as a continuation of
this tract in the cerebrum corresponds to Bechterew's central
cerebral tract (Centrale Haubenbahn) ; this tract is said to be
in relation with the olivary tract but not in the sense claimed
by Helweg, according to whom there is a direct continuation
of the triangular tract. The two tracts are supposed to constitute,
on the contrary, one system of fibres that is interrupted in the
olivary body.
In Bechterew's illustration {Text book on the cerebral an(i
spinal tracts), relating to the most proximal periolivary tract,
this tract is triangular, external in relation to the pyramidal
tract, alongside the margin of the medulla oblongata and its
antero-internal side is in contact with the bulbar olive. Accord-
ing to Bechterew, it disappears abruptly at the level of the lower
end of the bulbar olivary body.
In a later publication Bechterew claims never to have said
that Heiweg's triangle presented a system of ascending fibres,
as was interpreted from some statements made in his previous
works. It certainly seems from his statements that the tract
is in relation with the lower olivary body; nevertheless, up to
the present time there is no positive proof of this and the term
fasciculus periolivarius used by Bechterew indicates only a rela-
tion near to the olivar}^ body.
Bechterew claims that the fibres of Heiweg's area become
covered with a myelin sheath quite late, after the pyramidal
tract, so that its development is added only after birth.
Ghiese confirms this opinion. In the medulla oblongata of
a child one day old I did not find any myelin fibres either in
the pyramidal or in Heiweg's tract, while in the medulla of a child
nineteen days old there was decided myelinization of both tracts ;
and I could see Heiweg's tract in the proximal end of the medulla;
the tract appeared triangular externally to the pyramidal tract,
as indicated by Bechterew, extending to the beginning of the
distal end of the bulbar olivary body, where it disappeared ab-
ruptly. I could not trace it higher up. In two serial sections oi
the medulla oblongata of adult men the results were negative:
these sections were made in the sagittal and vertico-transverse
(frontal) planes, but I could find no trace of the extension of
Heiweg's tract.
THE HELWEG-WESTPHAL TRACT— Dr. Giannelli. 5
On the other hand, the so-called degenerations, more or less
marked, of this tract mentioned in literature do not furnish any
|X>sitive data on the proximal end of Helweg's tract.
It is claimed that Helweg was of the opinion that the tract that
bears his name could be found in the insane only, and that in
such cases it extended beyond the olivary body into the cerebrum.
Reinhold, who has studied its course in cases of hemorrhage
into the floor of the fourth ventricle, could not trace it proximally
beyond the end of the pyramidal decussation (Fig. 5, in Rein-
hold).
In Pick's five cases* Helweg's tract was quite recognizable,
and he claims to have seen rarification, about the periphery of
the olivary body, which gradually decreased upward with the de-
crease of the olivary body in the same direction ; besides. Pick
claims that the course of Helweg's and the pyramidal tracts was
parallel. Still Obersteiner remarks that perhaps in Pick's cases
there was rather a marked clearness of the triangular tract quite
independent of any degeneration of the pyramidal tract.
Obersteiner has found the triangular tract in the medulla ob-
longata of tabetic subjects; Elsholge — in subjects who died of
taboparalysis, progressive paralysis and cerebral tumors ; Min-
gazzini and Perusini — in a case of Friedreich's disease. Yet in
none of these cases is there any precise indication as regards the
proximal end of the tract; in the last two cases its proximal end
is claimed to have been at the level af the most distal part of the
medulla oblongata and lateral to the pyramidal tract ; the authors
of these cases say that it was difficult to ascertain how much of
this apparent tract represented peripheral degeneration and how
much degeneration or rarification of the triangle properly speak-
ing.
Recently Obersteiner published a case as follows : tumor of the
floor of the fourth ventricle involving the right side; marked
compression of the olivary body ; descending degeneration of the
triangular tract that could be followed downward to the begin-
ning of the dorsal region of the spinal cord ; in the cervical region
of the spinal cord the degenerated area occupied exactly the
* Pick identifies Helweg's triangle with Lowenthal's anterior mar-
ginal tract (faisceau marginal anterieur). Pick: Ueber den fasciculus
intermedius (Lowenthal), mit Bemerkungen iiber den fasciculus mar-
ginalis anterior (same author). Beitrage zur pathol. und pathol. Anatomic
des Centralnervensystems, Berlin, 1898. Lowenthal. La region pyra-
midale de la capsule interne chez le chien et la constitution du cordon
antero-lateral de la moelle, Revue medicate de la Suisse romande, Sept.
15, 1886.
6 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
region of Helweg's area. In its dorsal side, however, an arcate
prolongation penetrated from it into the lateral tract; at the
periphery the triangular tract was separated by a layer of normal
fibres. However, the case does not present any data for estab-
lishing the proximal origin of the triangular tract.
Thomas also claims to have seen descending degeneration of
the fasciculus centralis tegmenti and of the area corresponding to
Helv/eg's tract subsequent to a homolateral hemorrhage of the
tegmentum; he says that the fasciculus centralis tegmenti con-
sisted mostly of descending fibres which ended in the olivary body,
while others probably formed part of Helweg's tract.
Finally there are some cases published in which the authors do
not consider the areas of degeneration or rarincation found by
them as really representing Helweg's tract. In the description of
his tract, in w^hich he considered it as a vaso-motor path, Heiweg
identified it with the tract previously described by Westphal in
two cases, localizing it at the transition line between the cervical
spinal cord and the medulla oblongata. When speaking of the
degeneration of this tract it would seem proper, therefore, to
couple it with the name of the author who first called attention
to it. Heiweg does not say, however, that Westphal did not feel
himself authorized to ascribe a pathologic significance to the
zone composed of fine and very fine fibres (so halte ich nicht nach
sorgfaltingster Pruefung vorlaufing nicht fuer berechtigt, diesem
Befunde eine pathologische Bedeutung zuzuschreiben).
Obersteiner holds that Hehveg's triangle corresponds to the
area of degeneration described by Meyer before Heiweg pub-
lished his case of hemorrhage into the tegmentum at the level of
the nucleus of the seventh pair. The degeneration extended down
to the third cervical segment. It seems to me, however, that this
position does not exactly correspond to Helweg's area. At the
level of decussation 'of the sensory tracts the surface of the sec-
tion is triangular in shape (Meyer, fig. ii), but is situated behind
the com.pact pyramidal tract, with its base turned to the periphery
of the spinal cord, its apex touching the longitudinal fissure. At
the level of decussation of the motor tracts the small triangular
area is situated at the periphery of the lateral column, limited by
the anterior roots. In fig. 12, it is presented rather as being in a
condition of rarification, and is separated from the periphery by
a thin layer of closely set fibers.
Spiller described a tract that underwent descending degenera-
tion subsequent to hemorrhage of the cerebral hemisphere, and
wliich, according to Obersteiner, might present homolateral de-
scending degeneration of the triangular tract. It seems to me that
THE HELWEG-WESTPHAL TRACT— Dr. Giannelli. 7
such a possibility should be excluded. At the level of issue of the
fifth pair this tract is lateral to the pyramidal tract, then directed
abruptly behind and downward across the trapezoid body; at the
point of junction with the medulla oblongata it takes a lateral
position — above the bulbar olive ('*a position lateral to the upper-
most portion of the inferior olive"). Where the olive has its
fullest dimensions, however, the tract is situated at the postero-
lateral side of the olive itself (Spiller, fig. 8), while Helweg's
area is situated at the externo-lateral side of the olive. In the
medulla oblongata Helweg's zone is more anterior than is indi-
cated by Spiller.
The tract described by Spiller represents a direct lateral pyra-
midal path.* It is more probable, on the contrary, that Helweg's
tract corresponds to that described by Russel.**
When Hoche published his cases of paralytics in which he
found descending degeneration of the pyramidal tracts and of
Gowers' column, Obersteiner agreed with Pick that probably
Helweg's tract was mistaken for Gowers' column.
From the facts considered it seems that there are no positive
data in literature as regards the proximal origin of Helweg's
tract; it is certain that proximally the tract is near the olivary
nucleus, but it does not follow from this either that it originates
or terminates in this nucleus. Obersteiner justly remarks, there-
fore, that the only way to resolve this question is to study true
degeneration of this tract ; and my case here described presents
a true degeneration ; it shows that Helweg's tract assumes the
form of a groove, a little before the beginning of the distal end
of the olive, within which the bulbar olive spreads out and is
embraced in its external half. In horizontal sections it appears
semi-circular, starting from the lateral end of the oliva accessoria
medialis, turns at first externally, then outward and backward,
finally abruptly inward, ending at the middle of the dorsal leaflet
of the bulbar olive.
The tract disappears, or commences, inside the bulbar olive, in
its lower two-thirds ; in its most proximal part there is no trace
whatever of the tract.
* See Stewart Purves. Degeneration following a traumatic lesion of
the spinal cord, with an account of a tract in the cervical region, Brain,
II, p. 222.
Harness Stanley. Degeneration in hemiplegia, with special reference
to a ventro-lateral pyramidal tract, the accessory fillet and Pick's bundle,
Brain, II, p. 463.
** Brain, p. 145.
Journal of Nervous and Mental Disease, 1897.
8 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
REFERENCES.
1. Bechterew. — Les voies de conduction du cerveau et de la
moelle. French edition, 1900.
Ueber das Olivenbuendel im Cervicaltheile des Rueckenmarks,
Neurolog, Centralb., 1894.
Ueber ein wenig bekanntes Fasersysteme an der Peripherie des
anterolateralen Abschnittes des Halsmarkes, Neurolog. Centralh.,
S. 194, 1901.
2. Giesse. — Topographic de la substance blanche de la moelle
de rhomme d'apres des recherches embryologiques, These de
Petersbourg, 1893.
3. Helweg. — Studien ueber den centralen Verlauf der vaso-
motorischen Nervenbahnen, Arch, f. Psychiatric, XIX, 1888.
4. Meyer. — Ueber einen Fall von Ponshaemorrhagie, Arch. /.
Psych., Bd. XIII, 1882.
5. Mingazzini and Perusini. — Two Cases of Familial Heredo-
Spinal Atrophy (Freidreich's Type), with one Autopsy and one
Case of so called Abortive Form of Freidreich's Disease, The
Journal of Mental Pathology, Vol. VI, Nos. 1-2, 3-4 and 5,
1904.
6. Obersteiner. — Bemerkungen zur Helweg'schen D!reikan-
tenbahn. Arheiten aus dent neurologischen Institut an der
Wiener Universitat, 1900, VII, Heft S., 286.
Ueber das Helweg'schen Buendel, Neurol. Centralh., S. 546,
1901.
7. Pick — Beitraege zur pathologischen Anatomic des Central-
nervensystems. Ueber ein wenig beobachtetes Fasersystems,
Berlin, 1898.
8. Reinhold. — Beitrag zur Kenntniss der Lage des vasomotor-
ischen Centrums in der Medulla Oblongata des Menchen,
Deutsche Zeitschr. f. Nervenheilk., Bd. X, 1897.
9. Spiller. — A Contribution to the Study of the Pyramidal
Tract in the Central Nervous System of Man, Brain, XXII.
Ueber den direkten ventrolateralen Pyramidenstrang, Neu-
rolog. Centralb., S. 534, 1902.
10. Thomas. — Societe de neurologic de Paris, seance du 15
Janvier, 1903. Abstracted in Neurolog. Centralh., S. 884, 1903.
11. Westphal. — Ueber einige Facile von acuter toedtlichen
Spinallaemung, Arch. f. Psych., VI, S., 765.
Rome, Italy, June 1906.
A CASE OF HYSTERIA SIMULATING THE
SYNDROME OF BROWN-SE'QUARD.
By Dr. Pietro Timpano.
It is well known that hysteria may manifest itself under various
clinical forms, even assuming aspects of organic diseases caused
by organic cerebro-spinal, circulatory, respiratory or other lesions.
The practitioner is frequently confronted with such cases, and
their diagnosis is so much the more difficult when the subjects
thus afflicted do not present any stigmata of hysteria or hereditary
neuropathic traits; indeed some such subjects do not present any
neurotic traits of hereditary or acquired nature that could aid in
the diagnosis of their affections. The physician is often so much
misled in the diagnosis of such cases that he makes his diagnosis
on the basis of an organic lesion and institutes treatment accord-
ingly; the ineffilcatiousness of a prolonged treatment of this kind
that puts the physician on his guard is often the main factor in
leading him to make a correct diagnosis. To-day hysteria is
recognized as being a proteiform neurosis par excellence.
The case that I shall relate below is descriptive of hysteria that
simulated classically Brown-Sequard's syndrome (caused, as is
known, by hemisection of the spinal cord).
The patient, A. S., was a peasant girl, 20 years old, born in
Bbva, Italy. Her father enjoys excellent health, has never in-
dulged in alcoholic drinks or in smoking, and his conduct has
alway been that of a normal man. The mother, on the contrary,
presents some stigmata of hysteria : narrowing of the visual field,
complete absence of the pharyngeal reflex and hypoesthesia of the
left side of the body. She is highly irritable and excitable, the
slightest worry causing her to have a convulsive fit. The patient
is the only child she has had ; the pregnancy was normal in every
respect.
10 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No, i
The patient menstruated for the first time when 13 years old.
When 18 years of age she had typhoid fever, and during convales-
cence from this disease she first presented marked changes in her
character: when reprimanded she showed excessive anger and
refused to speak or to eat during such days. Since the attack of
typhoid fever she became highly excitable and irritable. Janu-
ary 12, 1906, while sitting in front of her house, two men ran by,
fighting, one plunging a knife into the back of the other. Fright-
ened by the sight of the assault, she got up and tried to run into
the house; she only made a few steps, however, and fell sense-
less. She remained so for some time before her mother and
cousin found her still lying senseless — on her right side. She
was picked up and carried to her bed, where she remained in a
semi-conscious condition for over a month : her eyelids were half
closed, the eyes turned upward and the respiration was stertorous.
Her parents succeeded, however, in making her tell what had
happened to her. In a low tone of voice she said that the sight
of the two fighting men had frightened her, that she tried to run
into the house, but that she had fallen, powerless to proceed.
When somewhat reassured, she tried to turn in her bed, but found
that her left lower limb was paralyzed. I was then called in to
see her.
Objective Examination. — The patient is of medium stature,
normal muscular and adipose development and rather pale. She
has right plagiocephaly, narrow and slanting forehead. Wilder-
muth's ears. Normal and well-developed teeth; the hard palate
is rather high and narrow. The thorax is well formed, but the
breasts are underdeveloped; the abdomen is rather flat and the
pelvis quite narrow ; the limbs are well formed ; when the patient
is lying on her back, the lower left limb is turned outward. The
heart and lungs are normal, although the pulse is somewhat rapid.
The stomach, liver and spleen seem to be normal.
General Sensibility. — Tactile, dolorific and thermic anes-
thesia of the entire right lower limb and that part of the right
side of the body which is limited by the median line and one pass-
ing eight centimeters above the umbilicus. The anesthesia is
absolute only in the limb, up to its root, and diminishes in in-
tensity higher up. There is no zone of hyperesthesia and the
muscular sense is normal. On the left side general sensibility is
normal, except for a zone of hypoesthesia, the size of the palm
of the hand, situated in the middle of the anterior thorax. There
is also a zone of hyperesthesia in the left lower limb, extending
from the knee to the ankle; the muscular sense is considerably
impaired in the entire limb.
HYSTERIA SIMULATING SYNDROME OF BROWN-SEQUARD.— Timpano. h
Special Sensibility. — The sense of taste, olfactory sense and
hearing are normal. The visual field is concentrically narrowed
on both sides, but more on the right side. Visual acuteness is
normal. Dyschromotopsia for green only.
Motility. — No disturbance of the facial, ocular, lingual, la-
ryngeal or pharyngeal muscles. Active and passive muscular
movements of the upper limbs normal. Muscular strength is
somewhat impaired in the left upper limb. Fine tremors of the
hands when extended. Complete paralysis of the left lower limb,
its muscles being in a condition of hypotonia ; passive movements
are easily made. When made to walk the patient drags her lower
Imib, but the right one is normal.
Reflexes. — Pupillary reaction to light and accommodation is
more marked on the left than on the right, but the pupils are of
equal size on both sides. The pharyngeal reflex is absent. The
abdominal reflex is impaired. Knee reflex — marked on the left,
but impaired on the right side. Plantar reflex abolished on the
right and only slight on the left side. Foot clonus abolished.
Psychic Examination. — The patient is somewhat depressed
and preoccupied. No trouble in articulated speech. She is
conscious of her surroundings in every way and has neither delu-
sions, illusions nor hallucinations. Memory normal, although
ideation is somewhat slow. The patient admits that she is afraid
of catching diseases (nosophobia) and of remaining in the house
where she lives (topophobia). Affective sphere normal. In-
stincts normal.
Summary of the symptoms :
On the right: tactile, dolorific and thermic hemianesthesia of
the lower limb and that part of the body which is limited by the
middle line and that passing eight centimeters above the umbili-
cus. Muscular sense normal. Reflex to light and accommoda-
tion normal; plantar reflex absent and knee reflex impaired.
Active and passive movements normal in the upper and lower
limbs, although there is a slight decrease of the muscular force
of the upper limb.
On the left: hemiplegia of the entire lower limb. Tactile, do-
lorific and thermic sensibility normal ; small area of hypoesthesia
on the anterior thoracic wall, between the 4th and 5th ribs ; a
band of hyperesthesia in the paralyzed limb, extending from the
knee to the ankle; muscular sense impaired in the entire lower
limb. Reaction to light and accommodation more marked than on
the right side ; knee reflex marked ; plantar reflex impaired.
The condition characterized by these symptoms is certainly
analogous to that characterizing Brown-Sequard's syndromic:
12 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
hemiplegia on the side of the lesion and hemianesthesia on the
opposite side. In the case of the patient, however, the symptoms
set in suddenly, lasted twelve days and disappeared suddenly.
Considering these facts, together with the patient's hysterical
stigmata, the diagnosis of hysteria appears evident. If we were
to point out an organic disturbance in this case it could be local-
ized on the left side of the spinal cord, between the last thoracic
and the first lumbar vertebrae. In this position a lesion would cause
paralysis of the lower limb on the same and anesthesia on the
opposite side. There would also be marked impairment of the
muscular sense and hyperesthesia in the paralyzed limb, while
the muscular sense would remain normal in the limb with an-
esthesia. The knee reflex would be more marked on the side of
the lesion. It is true that in the classic syndrome of Brown-
Sequard the symptomatology may be far more complex, but it is
not always found to be such in all cases ; in fact, in some instances
only a few characteristic symptoms represent this syndrome.
Hence in this case there are quite sufficient symptoms to consti-
tute Brown-Sequard's syndrome. It is reasonable to suppose that
in this case the functional disturbance that had caused the trouble
brought about a local disturbance in the spinal cord, on its left
side, between the last thoracic and the first lumbar vertebrae:
this lesion caused an interruption of function of the pyramJdal
tracts, Gower's column, the direct cerebellar tract, etc.
The pathogenesis in this case can be explained on the basis of
neurotic heredity on the mother's side, and the etiology must-
certainly have been the fright sustained by the patient, as has been
stated above. As there was no organic lesion in this case, the
mechanism of the pathogenesis is of interest. Clinical experience
shows that the syndrome of Brown-Sequard may be caused by a
lesion not necessarily involving the spinal cord properly speaking,
but some region in its vicinity. Sciamanna (Annali del'istituto
psychiatrico della R. Universitd di Roma, Vol. Ill, No. i, 1904)
published a case of this kind and called the syndrome reflex syn-
drome of Brown-Sequard, in contrast to the classic one caused
by hemisection of the spinal cord. He claimed that with a lesion
not involving the spinal cord properly speaking but in its vicinity,
the corresponding half of the spinal cord could be actually af-
fected as if it had sustained hemisection ; the syndrome that fol-
lowed was therefore quite like that found in the typical syndrome
of Brown-Sequard. I also published a similar case in the Journal
OF Mental Pathology, Vol. VI, Nos. 3-4, 1904. Not all authors
accept Sciamanna's explanation of the mechanism of the patho-
genesis in such cases (functional local disturbances of reflex
HYSTERIA SIMULATING SYNDROME OF BROWN-SEQUARD.— Timpako. 13
nature) ; they prefer to explain the condition on the basis of in-
hibition of the perceptive centres.
In my case the reflex nature of the trouble should be excluded
because no trauma had been inflicted directly or indirectly; the
sudden emotion was the only causative agent. On seeing
the assailant plunge the knife into the back of his victim the
patient was so deeply impressed that she felt as if the blade were
penetrating her own flesh in the region of her spinal cord. This
vivid impression may have caused phenomena of inhibition in the
motor and sensory cerebro-spinal centres of the limbs, causing
paralysis and anesthesia as was described above. This case may,
therefore, be termed as one of Brown-Sequard's syndroms of
psychic origin.
While this patient had not sustained any trauma that might
have caused the trouble of the spinal centres, it should be borne
in mind that she fell while trying to run into the house. Yet
whatever trauma her lower limb may have sustained in this fall,
the apparent focal centre of injury cannot be explained by that
trauma. In hysterical subjects a slight trauma of a limb may
often be the cause of paralysis in the same; but in this case the
trauma was received in the right limb, while the paralysis was
located in the left one. The trauma may have caused the anesthe-
sia recorded above, but taking all the symptoms together, it is
more reasonable to suppose that the intense impression caused
by the sight of the assault brought about inhibition of the motor
and sensory centres of the lower limbs, causing Brown-Sequard's
syndrome of psychic origin.
PHYSIOLOGIC EFFECTS FOLLOWING SUCCES-
SIVE ABLATION OF ONE FRONTAL LOBE
AND ONE CEREBELLAR HEMISPHERE.
(From the Laboratory of Neuropathology, Prof. Mingazziniy
Romey Italy.)
By Prof. G. Mingazzini and Dr. Osv. Polimanti.
In this note we present our researches into the results following
successive extirpation of one cerebellar hemisphere and one fron-
tal lobe of the cerebrum either on the same or the opposite side.
So far as we know we are the first to publish such researches.
Luciani and S. Sergi have published the results of extirpation
of one cerebellar hemisphere preceded by extirpation of the Ro-
landic region on the opposite side. Our experiments were made
on dogs, and we obtained the following results :
1. Extirpation of the frontal lobe (in dogs — the entire part of
the cerebral hemisphere in front of the sigmoid gyrus) is always
followed by the symptoms described by Munk : tendency to turn
from the healthy to the side on which the operation took place
(manoeuvre movement) ; we also observed slight ataxia of the
anterior limb on the side opposite to that on which the extirpa-
tion took place ; when this ablation is followed by hemicerebellar
ablation on the same side the operation is followed not only by
ataxia and asthenia homolateral with the cerebellar (and frontal)
side, but there is also an aggravation of the ataxia (that followed
the previous operation) in the anterior limb on the opposite side.
2. Ablation of the frontal lobe on the same side on which one
cerebellar hemisphere had been previously extirpated is followed
by increased ataxia and asthenia of the limbs on the same side on
which the ablation had been performed as well as by quite
marked ataxia (incoordination) of the anterior limb on the oppo-
site side.
3. Ablation of one cerebellar hemisphere on the side opposite to
that on which the frontal lobe had been extirpated is followed not
only by asthenia and ataxia of the limb on the same side on which
the cerebellum had been destroyed, but the ataxia and asthenia
that has already been caused in the same limb by the extirpation
of the frontal lobe is markedly increased
ABLATION, FRONTAL AND CEREBELLAR HEMISPHERE. 15
4. Ablation of the frontal lobe in a dog which had already
sustained extirpation of the cerebellar hemisphere on the opposite
side is followed by aggravation of the ataxic and asthenic symp-
toms of the side opposite to that on which the cerebellar hemi-
sphere had previously been extirpated.
Homolateral hemi-fronto-cerebellar extirpation is followed by
ataxia and asthenia in both sides of the body, but is more marked
on the side of the extirpation; the animal presents syndromic
manifestations quite similar to those following bilateral extirpa-
tion of the cerebellum. Contra-lateral hemi-fronto-cerebellar ex-
tirpation is followed by ataxia and asthenia on one side only —
that on which the cerebellar extirpation is performed ; and these
disturbances are far more marked than those following isolated
hemi-frontal or hemi-cerebellar extirpation.
Hence, if extirpation of one frontal lobe causes slight ataxic
and asthenic disturbances of the anterior limb on the side oppo-
site to that on which the operation is performed, disturbances
similar to those following unilateral extirpation of the cerebellum,
and if extirpation of one frontal lobe, on the same side on which
the cerebellar hemisphere had previously been extirpated, aug-
ments the ataxic disturbances that have already existed and
causes them to appear, although in a minor degree, on the oppo-
site side, the conclusion seems to be that the frontal lobe has, not a
direct, but an indirect action on coordinate moveinents of the
limbs on the opposite side ; the ataxic and asthenic symptoms that
we have observed under the various conditions differed only in
degree from those caused by cerebellar ablation. Everything
points to the fact that each frontal lobe has an influence on co-
ordination of movements of the limbs on the opposite side and
particularly on the anterior limb.
Some authors interpret the ataxic symptoms that follow abla-
tion of the frontal lobe as an effect a distance on the cerebellar
hemisphere on the corresponding side. This does not seem to us
to be correct, because then only the limbs on the same side should
present ataxic disturbances, whether the frontal ablation preceded
or followed the cerebellar ablation; besides, the disturbances
should then be only transitory. But frontal ablation after cere-
bellar extirpation on the opposite side causes aggravation of the
ataxic symptoms (incoordination) on the opposite side (on the
same side on which the disturbances had been caused by cerebellar
ablation) ; similarly, frontal ablation on the same side on which
cerebellar ablation has existed causes bilateral symptoms similar
to those caused by complete cerebellar ablation.
THE GENESIS OF SEX.
By Louise G. Robinovitch, B. es L., M.D. Paris, Member, New
York Academy of Medicine; Member, Americcm Medical
Association; Foreign Associate Member, Medico-
Psychological Society, Paris *
This paper is practically an introduction to my paper "The
Genesis of Genius," published in the Journal of Mental Path-
ology, Vol. VII, No. 5.
General Considerations. — Researches into the cause of sex
determination have been made by various investigators, but so far
little light has been throwm on the subject. Shenk's theory, based
on the dietetic principle, created quite a sensation, but unfortu-
nately the medical profession at large has not investigated the sub-
ject with any perseverance, and no definite conclusions as to the
merit of his claims have been reached.
The drawback to the progress of this investigation is our in-
difference to it. Many of us shrug our shoulders when the
importance of the question is presented to us, and we readily fall
into line with those who say that nature is taking proper care of
the proportion of men and women to be brought into the world.
From the gross point of view, the natural equality of distribution
of the sexes leaves nothing to be desired. Certainly, if all other
conditions of life harmonized with an even proportion of the sexes,
we should be justified in our indifference and in the acceptation of
the dictum of the conservatives who claim that the equal propor-
tion of the sexes as provided by nature is a wonderful provision
that should meet with our respect.
Unfortunately, the harmony that should exist is conspicuous by
its absence. Indeed, the equal proportion of males and females
* Scheduled for the XVth International Congress of Medicine, held at
Lisbon, Portugal, April, 1906, and the Vlth International Congress of
Criminal Anthropology, held in Turin, Italy, April, 1906.
THE GENESIS OF SEX.— Dr. Robinovitch. 17
provided by nature is the main cause of a constant and continuous
superfluity of one sex, as we shall show, and such a division of the
sexes is intended for a society far different in structure than is that
peopling the earth. Take, for instance, the uncivilized peoples,
who, like ourselves, enjoy the provision of nature whereby 509^
more or less, of each sex is born, and consider what becomes of
the feminine moiety of their respective populations. A large num-
ber of the baby-girls are either drowned or strangled at the time
of birth, or else, if allowed to live, are sold at tender ages as slaves,
or worse.
What concerns us most directly in the consideration of this
subject, however, is the fact that mothers, families, societies and
nations that currently kill their baby-girls or sell them when grown
up give nature the lie, so to speak. The aim of such peoples is
apparently to relieve themselves of a heavy burden that female
children bring into households, and probably also to save their
female offspring an unbearable burden that awaits them at
mature age. It seems, therefore, that the wisdom of nature, in
providing an equal division of the sexes, a division that dogma-
tists caution us against questioning, is most questionable in the
light of conditions that obtain among the infanticidal peoples.
The reader will perhaps say that the Eastern peoples, which
find themselves overburdened with one sex, are no criteria for
us, — that civilization is gradually leading to social improvements
and sacredness of individuality, and that any attempt at artificial
increase or decrease of one or the other of the sexes is a violation
of nature's provision which we should not countenance.
If it be true that civilization is working improvements for
society at large, it remains also true, nevertheless, that civilized
society also suffers from superfluity of the feminine sex. I refer
the reader to my paper entitled "Remarks on a Specific Human
Energy and its Economic and Social Significance", in the
Journal of Mental Pathology, Vol. VII, No. 3, 1905, p. 123,
in which the following statements regarding the excess of women
over men in England is made :
"In plain English, there is in England at the present moment
a sex ^famine', which, unless the ladies are exported in millions,
is likely to increase rather than diminish", etc.
Polygamy is also mentioned as a means for counteracting the
overabundance of the female sex. It has seriously been sug-
gested that the superfluous Englishwomen be exported to Japan,
thus helping to raise the standard of the Japanese stature. It is
worthy of note that no English country or other country to which
one would presume Englishmen have emigrated, is suggested as
l8 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
the proper place for this export. The reason that no such
suggestion is made is that there is no superfluity of Englishmen
anywhere.
, These data show, therefore, that while civilization is causing
betterment of society and abolishing wholesale strangling of
female offspring, the facts remain, nevertheless, that the civilized,
like the uncivilized nations, have their superfluity of women.
Among the civilized countries, England does not stand alone in
having a superfluity of women. Indeed, according to Frau
Gnauck-Kuehne, there is a superfluity of women in many Euro-
pean countries. And while the excess of women over men abroad
is probably the result of necessity (economic and social conditions)
cur own "bachelor girl" is the result of her free choice, but
directed by the same conditions — economic and social, but which
spell necessity elsewhere.
I shall not stop to consider these interesting questions, but
shall pursue the thread of the argument regarding nature^
mathematical provision of the proportion of the two sexes and
consider whether we are justified in shrinking from the study
of the genesis of the sexes — with a view to controlling the
proportion of male and female births.
So far as unprejudiced reasoning dictates, there is not only
ample justification for such a study, but even an important
necessity for it. Indeed, it should not be considered natural
for human society to have an excess of one sex, leading to
wholesale infanticide among the less civilized nations, and to
a living superfluity of the same sex among the more civilized
nations. No argument can blind us to the fact that a super-
fluity of the female sex exists among all peoples — whethei
civilized or uncivilized. For, as we know, nowhere is there
any corresponding excess of the male sex to the extent of
prompting alarmists to plead for legitimate polyandry, in
analogy to legitimate polygamy in order to counteract a "sex
famine". There may be a few remote farms in the back-
woods of some countries, where a larger influx of women
would be desirable, but certainly the "sex famine" in those
supposed farms is a negligible quantity when compared with
the marked superfluity of women from which, we are told,
England is suffering to-day.
Whence comes the superfluity of women — in face of nature's
wise division of the sex proportion?
Those who would reply that the constant emigration of
men from England explains the disproportion in that country
between the number of men and women respectively are mis-
THE GENESIS OF SEX.— Dr. Robinovitch. 19
calculating. Yet, how is one to explain the apparent paradox:
an equal number of births for males and females, and a re-
sultant superfluity of women over men? The riddle is not
impossible of solution. Indeed, economic conditions that must
govern all peoples explain this artificial result. Experience
has led society to realize that it is important for a man to
reach maturity — in age, work and capability — before he can
honorably claim a woman as his mate. The Greeks made it
difficult for a man to enter the married state before the age
of thirty. To-day, the same conditions, self imposed, obtain
in this and in other civilized countires. The question of age
at the time of marriage is considered, from a different point
of view, in my paper mentioned above, and in Prof. Marro's
work tables are adduced showing that the higher a nation's
civilization, the higher is the average age at which man marries.
In the most progressive countries of to-day the majority of
men marry at the age of from 30 to 35 years. A man of
from 30 to 35 years of age seldom marries a woman of similar
age; he is most apt to chose a woman younger than himself.
Now, for the sake of argument, let us suppose that we have
established a town artificially, in which civilization is exactly
like our own, that we have peopled it according to current
birth rates provided by nature, putting into that tow^n an equal
number of males and females respectively, but in which the
oldest men and women are from 30 to 35 years of age. In
order to make of this population an exact counterpart of what
it would be if it constituted a certain percentage of an ordinary
highly civilized nation, we should suppose that male youths and
those less than 30 to 35 years old are unmarried. In fact, let
us suppose that our artificial community, constructed by us
according to nature's provision of 50% of each sex, and civil-
ization's restriction of the age at which man may honorably
marry, is to celebrate to-day for the first time in its existence
marriages among its citizens. According to the conditions im-
posed on us by civilization, the eligible men for marriage are
only those between 30 and 35 years of age. Let us suppose
further that the population consists of 800 males and 800 females
in the following proportions:
Men. :
Age.
Women.
Age.
200.
Under 20.
200.
Under 20,
200.
20-25.
200.
20-25.
200.
25-30-
200.
25-30.
200.
30-35-
200.
30-35.
Let us suppose now that the first men to enter the married
20 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
State are those between 30 and 35 years of age. Barring ail
exceptions, these men will surely choose in marriage the women
younger than themselves, in either of the three groups of women
comprising subjects between the ages under 20 and not above 30.
Hence, in this small community of 800 males and 800 females,
the marriage of the first 200 eligible males is followed by a
superfluity of two hundred women. That these women, be-
tween 30 and 35 years of age enter into the category of the
superfluous goes without saying.
The above schema shows that a marked superfluity of
women may exist even when the absolute proportion of the
two sexes is equal, — 50% of each. Although the schema is
artificial, it corresponds pretty well to what takes place in a
population of vaster numbers. It is not necessary to consider
here the absolute superfluity in the number of women as it is
said to exist in some countries, as the proposition considered
here is that the 50% of each sex provided by nature leads to
a superfluity of women in societies ; yet the morality of the
latter should be built by both sexes equally as both are engaged
in the struggle for existence. Although the number of super-
fluous women is exaggerated in the schema for the sake of
demonstration, it nevertheless represents exactly the conditions
that prevail in natural communities millions of times larger in
number than 800. For it should be borne in mind that men
and women of the same generation live and die within the same
period of years. Consequently, every generation starts its own
superfluity of women and dies with it. It seems unnecessary
to stop to demonstrate here that there are still other factors
contributing to superfluity of women, such as the frequent
marriages of senile widowers with very young girls, and of
widows with single men. But the argument presented here,
showing that nature's equal supply of men and women respec-
tively leads to superfluity of women, is sufliciently clear to need
any further consideration. Economic and social factors help to
upset nature's equilibrium in the proportion of the sexes by
causing superfluity of women — ^both in the civilized and un-
civilized countries. The only difference in the reaction of the
respective countries against this condition is in form : among
the uncivilized peoples the reproach to nature is expressed by
wholesale infanticide of females, while among the Europeans
superfluous womankind is either moping or conquering for it-
self a prominent position in the domain of hysteria; and last,
but not least, our own "bachelor girl," with her innate sense of
individuality, clear appreciation of existing facts and her high
THE GENESIS OF SEX.— Dr. Robinovitch. 2I
demand on manhood, towers far above her sisters abroad in
that she is the chooser rather than the unwilUng acceptor of
her civil state.
From the point of view just examined, it would be of advan-
tage to learn how to control the genesis of the sexes. The
application of such knowledge should be valuable in many
practical ways, of which only a few may be touched upon
here: it is not right, for instance, to regard with equanimity
th€ wholesale slaughter of infants because of sex; nor to treat
with indifference the melancholic superfluous woman of
Europe, who is brought up to believe that she is disgraced
unless she can become the wife of some man or of any man;
and it is not right to tolerate conditions which, by reason of
superfluity of women, greatly contribute to the existence of the
horrible triad — syphilis, gonorrhea and alcoholism — with the con-
sequent increase of insanity, criminality and degradation of
nations (i).
Frcan whatever point of view the question of superfluity of
women is considered, it appears that sexual profligacy in man —
with its long list of consequent social evils is the result therefrom.
After all, the question of the government of sex differs from that
•f the government of state only in kind : tyranny or excess in
cither leads to individual degradation and collective decay. The
only effective remedy for such evil is to learn how to control
the conditions that lead to surplus of sex, in the same manner as
Qne would seek to curb the tyranny of power or the centralization
of capital.
Those who inherently adhere to inertia in thought may say
that probably nature has some aim in providing conditions that
lead to superfluity of one sex, and that besides, the discovery of
an anti-syphilitic and anti-gonorrheal serum would invalidate the
argument pleading against sexual profligacy in man. That such
a discovery will soon be made is not only most probable but is
earnestly to be hoped for, but not if it be meant to foster and
encourage sexual excess. For the function of sex, like all other
physiologic functions, requires moderation, and any excess im-
posed on it spells degradation — individual as well as collective.
This is particularly true as applied to sexual function of man, in
whom it is almost inseparable from that of reproduction. And
as "reproduction is essentially a process of nutrition" (2), in-
volving the entire cellular mass of the system, overindulgence by
man in sexual function results in undermining of his system.
For, according to Hermann, (quoted by Dr. Mary Putnam Jacobi,
in 'The Question of Rest for Women During Menstruation," p.
22 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, N«. i
i68), the ordinary cost of reproduction is the same in both sexes.
The history of nations is amply illustrative of the fact that
national decline and extinction has always followed on the trail
of conditions that brought about current sexual excess.
Public ignorance of the physiology of the human system and
especially of the function of sex is largely responsible for sexual
excesses among men. But medical men are waking up to this
fact and it is not rare now-a-days to find frequent statements
in the medical press that sexual continence is not only harmless
but beneficial in many cases (3). American Medicine, July i,
1905, remarks editorially, in part that "it should be an easy matter
to convince the developed man that continence can be a normal
state for civilized man. The ordinary excretions can be explained
as normal phenomena which are absolutely harmless, if not bene-
ficial. They, of themselves, occurring as they do in sleep, are
sufficient to prevent degeneration of the sexual apparatus frorri
disuse, and, indeed, there is no evidence at all that continence,
even without these phenomena, ever results in harm. All this
instruction, together with a complete study of the anatomy and
physiology of the sexual system, is not only proper but is an
essential part of a high-school education, though it should be in
the hands of physicians. ... In time, the surviving civilized
bachelors will be continent through the elimination of all others,
but it is a long way off." Professor Marro, in his work "La Pu-
berte chez THomme et chez la Femme," justly remarks that mental
work is a hypnotizer against sexual appetite, or an anaphrodisic
agent. But the millions of people, whose mentality is not called
into any particular active play are the incontinent who are fur-
nishing renewed vigor for the growth of the black plagues
syphilis and gonorrhea. Indeed, according to American Medicine,
January 6, 1906, p. 2, the enormous number of cases of these
diseases is yearly rising. "It is said that of the 770,000 male Amer-
icans who reach early maturity every year, 60% — nearly one-half
of a million — will become infected before they are thirty. Many
of these men marry before they are cured, and the infection of
wives follows, causing 80% of deaths from female inflammatory
troubles, 50% of gynecologic operations, and 80% of infantile
blindness. . . . The trend of civilization seems to be in the
direction of restricting the social evil by elimination of its de-
votees."
It should be borne in mind that the evil lies not in the super-
fluity of unmarried women, but in the increased sexual immoral-
ity of man that feeds on this disproportion or superfluity. If
science can discover a way of controlling the birth of the sexes.
THE GENESIS OF SEX.— D«. Robimovitch. 23
it is our first duty to bring such a discovery to light. There is
too great a disproportion between happiness that is and happi-
ness that should be the heritage of humanity. And an intelligent
control of the genesis of the sexes may help to bring about a
golden medium in human happiness.
Of course, it is possible that the mysterious working we are
pleased to ascribe to nature may, in the long run, accomplish a
readjustment of the proportion of the sexes; but it seems that
civilization is taking hold of this enterprise. Thus, for instance,
according to Frau Gnauck-Kuehne, the superfluity of women
in so many European countries is rapidly disappearing, and in
another twenty years there will be a superfluity of men even iti
such countries as Germany and England, where at the present
time women preponderate. In Luxembourg, in 1890, there were
I5O02 women for every 1,000 men, whereas there are now only
999 wpmenfor every 1,000 men. In Austria, the proportion has
been reduced in the same time from 1,044 to Ij035j i^ Hungary,'
from 1,015 to 1,009; in Switzerland, from 1,057 to i>035rJ^ii'
Sweden, from 1,065 to 1,049; ^^ Germany, from 1,040 to 1,032 •
in England, from 1,055 to 1,047 (4)-
If the above figures represent existing facts, they seem to
convey some interesting items for study. Indeed, according to'
this author, the gradual reduction of the proportion of women
to men is most marked in "advanced'* countries. The question
suggests itself, — what special conditions are there in advanced
countries that may possibly contribute to such a reduction ? In
an advanced country the main features are necessarily higher
national mentality and higher neuro-muscular force than in coun-
tries that are not advanced. Is it not probable, therefore, that
high neuro-muscular vigor has an effect on the genesis of the
sexes — in favor of male births? There is still another special
condition in advanced countries that contributes to heightened
neuro-muscular vitality of parents. As is well known, in ad-
vanced countries both men and women marry at a later age than
do people in countries that are not advanced. Prof. Marro (5),
presents an interesting table showing the ages at which marriages
take place in different countries. Russia heads all other Euro-
pean nations with the maximum of men and women who marry
under 20 years of age, (32.01 per 1,000 men, and 56.35 per 1,000
women). There is no parallel to these figures in marriages of any
civilized nations. In all the other countries examined the majority
of men marry between the ages of from 25 to 30 years, and
barring Russia and Buenos Ayres, the majority of women marry
between 20 and 25 years of age. Besides, the number of women
24 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
marrying between 25 and 30 years of age is minimum in Russia
(6.94 per 1,000) as compared with the figures for other countries,
in which the lowest is 12.41 per 1,000 for Buenos Ayres, and the
highest — 31.37 per 1,000 for Sweden.
I shall consider in another paper the importance of these
figures in so far as they bear on the neuro-muscular vigor in the
oflFspring (*). For our present purpose it suffices to remark
that the figures show that in countries of high mentality procrea-
tion is commenced at a period when both men and women are at
the height of neuro-muscular vigor. Confronting this fact with
the statement in regard to the decrease of female births in ad-
vanced countries, it again seems reasonable to suppose that the
determination of male births depends on the height of neuro-
muscular vigor of the parents at the time of conception of their
offspring.
That male births depend on high neuro-muscular potentiality
may also be inferred from the fact that college-bred women give
birth to more male children (55%) than do non-college-bred
women (45%) as was demonstrated in my paper "Remarks on a
Specific Human Energy and Its Economic and Social Signifi"
cance" (6). In that paper it is stated that college-bred women
marry later in life than do non-college-bred women, and that the
college-bred women marry educated and professional men more
than do the non-college bred women.
While this proposition is not improbable, we have not any suffi-
cient material in scientific literature to warrant a positive conclu-
sion in its favor. From the fragmentary data bearing on the
subject it may be concluded, however, that there is a correlation
between potential cellular energy of the parents and the genesis
of the sexes. Besides the theory I have presented as regards
such a correlation,! venture to suggest one more point in its favor :
I refer to the correlation that probably exists between the date
during the intermenstrual period at which conception takes place
and the probable sex of the child. I shall show later on that
cellular potential energy of woman is at its maximum about ten
days before the onset of the menstrual flow and that this maxi-
mum potential energy is probably a cause in the determination
of male issues of conceptions taking place at that period.
Some of our profession scoff at the idea of the probable relation
between the date during the intermenstrual period at which con-
ception takes place and the sex of the issue. Others, however,
think that the later in intermenstrual period conception takes
* See my paper entitled "The Genesis of Genius," published in The
Journal of Mental Pathology, Vol. VII, No. 5, 1906.
THE GENESIS OF SEX.— Dr. Robinovitch. 25
place, the more chance is there of the birth of a boy. Indeed,
Prof. A. Marro states, in his work already mentioned, p. 521,
that when conception does take place at such a period it results
most frequently in the birth of a male child.
The only statistical support in favor of this theory seems to me
to be in the fact that the Jews, whose religion forbids marital
intercourse during the period of five days preceding and ending
with the seventh day after the menstrual flow (7) give birth to
more male than female children. In the United States , where no
statement regarding the religion of the new-born is required
by the authorities, we have no means of verifying the claim;
Dr. A. Giannelli's (8) statement that Mayer and Salvioni's data
on this subject are not verified in the Province of Rome, where,
according to the census of 1901, there were more Jewish women
than men, needs elucidation; what is of importance to examine
is the birth rate as regards sex among the Jews, not the census.
The constant and heavy emigration that is going on in Italy may
account for the preponderance of Jewish women in the Province
of Rome. Hence, until it is disproven that Jews give birth to more
male than female children, we are justified in pursuing the thread
of the argument tending to show that high neuro-muscular vigor
of woman is probably a factor in the genesis of the male sex.
It is probable that high neuro-muscular vigor in the male parent
is also a factor in the determination of the male sex. Unfortu-
nately, we have no researches bearing on the cyclic physiologic
changes in man corresponding to that in woman. So that for the
present, one is forced to theorize on the ground of the data in
question relating to woman only.
The physiologic conditions of woman during the intermenstrual
period become of especial importance for consideration in the
light of the correlation between her cellular potentiality governed
by them and the sex of the issue of conceptions taking place
during these various stages. In view of the apparent correlation
between the time of conception during the intermenstrual period
and the birth of male children, as I have shown above, the study
of this cellular potentiality deserves particular consideration.
Physiologic Considerations. — In 1886, Dr. Mary Putnam
Jacobi presented her masterly experimental researches into the
rhythmic variations of the physiologic status of woman during
reproductive life (9). She demonstrated that '' repro-
duction in the human female is not intermittent, but incessant,
not periodical, but rhythmic, not dependent on the iwlitions of
animal life, but as involimtary and inevitable as are all the
phenomena of nutritive life'' (p. 165).
I
26 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
The mechanism by which provision rs made for the material
required in this "incessant budding" (p. 167), of woman is ex-
plained by Dr. Mary Jacobi in the chapter dealing with supple-
mental nutrition, that is not cited here.
"In woman exists a rhythmic wave of plentitude and tension of
the arterial system, at all events perceptible in the radial artery,
which begins at a minimum point, from one to four days after
the cessation of menstruation^ and gradually rises to a maximum,
either seven or eight days before menstruation, or at any day
nearer than this, or even during the first day of the flow
(p. 159).
"In all the detail examined, therefore, we find evidence of such
a gradual but steady preparation for the menstrual hemorrhage,
as should exclude the idea that this, when normal, has any ten-
dency to deplete the nutrition or lower the strength. It is to be
regarded as the simple equivalent of an accumulation effected
by a constantly rising wave of nutrition, primarily (in all proba-
bility), affecting the blood, but secondarily, and as a result acci-
dental to the main object of the wave, affecting the nervous and
muscular system through which that blood circulates. The blood
of the woman, non-pregnant, as well as pregnant, maintains con"
stant provision for the nutrition of offspring, just as the sap of the
tree contains constant provision for the nutrition of buds.
"The special variations of this blood, i e., as regards sex, are
all relative to this circumstance, but incidentally, the nutrition
of the woman's own organs is affected.
"If rich blood circulates in a slightly increased quantity, and
under a higher pressure, through the neuro-muscular organs,
the nutritive movements in their tissues are accelerated, and the
acceleration is marked by the increase of urea. When, in virtue
of the rhythmic movement inherent in their form of nutrition,
a portion of the nutritive fluids of woman becomes in excess of
their individual needs, this excess begins to accumulate in the
circulation, until finally, the tension becoming excessive, the
closed system gives way at its weakest point, the blood vessels
of the fattily degenerated uterine decidua, and hemorrhage
occurs.
"We find that in the majority of cases, the excretion of urea
i? increased during the few days preceding menstruation, over
that of the intermenstrual period; that it decreases during the
menstrual flow, and is at its minimum just afterward; that the
pulse shows no uniform rate of variation, but that the tempera-
ture rises just before menstruation, to fall during the flow, but at
this time rarely reaching the point of the intermenstrual period.
THE GENESIS OF SEX.— Dr. Ro»inovitch.
27
Finally, that the sphygmographic trace shows a constantly in-
creasing rise of arterial tension from a minimum point reached
just after menstruation to a maximum point just before, but
rapidly lessened during the menstrual flow" (p. 162).
"In the majority of women, the week preceding menstruation
is a period of increased vigor and consciousness of increased
nervo-muscular strength" (p. 162).
"The increased excretion of urea observed in the majority of
cases at the premenstrual period implies an increased movement
of nutrition, although not very marked" (p. 164).
"The rise in temperature indicates the same curve of oxidations
as the alterations in the amount of urea, and again, we are led
to suspect as a probable proximate cause, an increase in the num-
ber of blood corpuscles.
"Finally, the rise of the tension as indicated by the' sphygmo-
graphic trace, seems to intimate, for the reason above given; an
increase in the mass of the circulating fluid" (p. 164).
Inspired by Dr. Mary Jacobi's work, I took up the study of
variation in the number of blood corpuscles in woman during the
intermenstrual period. Some of these studies were made by me
in Dr. Jacobi's office, at her invitation, while others were pur-
sued with various interruptions while I was resident physician
in the Maternity and Philadelphia Hospitals, in Philadelphia, and
in the New York Hospitals for the Insane, in New York.
From the point of view here considered, such a study should
be made systematically and without interruption — conditions
that unfortunately did not prevail in my studies. Another condi-
tion of importance is the maintenance of an even diet and psychic
status. All these conditions could not be controlled in the cir-
sumstances under which I had to work, and' accurate results
should not be expected under these conditions. With this reserve
in view, I feel at liberty to state that while the number of the
blood corpuscles did not present any characteristic rise and fall,
a rhythmic increase and decrease is evident nevertheless during the
entire intermenstrual period — as was foreseen by Dr. Mary Jacotri,
the maximum corresponding to the period about a few days before
the onset of the flow. The irregularities accompanying the
curve depended on multiple causes, including changes of food
and psychic influences.
Dr. Alfredo Salerni recently published a paper dealing with the
periodic oscillations of the temperature, pulse and respiration of
insane women during menstrual and amenorrheal life (10). It
is regrettable that he was not guided by Dr. Mary Jacobi's
indications on the subject in normal women and that he, therefore,
28 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
accepts certain views on the mechanism of menstruation that
do not compare favorably with those presented by her. However,
in his results of the points studied he concludes that the maximum
vital energy, temperature, pulse and respiration of normal women
is expressed one or two days before the onset of the menstrual
flow and that there is an abrupt decrease of this energy below
the normal after the onset of the flow.
From all these researches we are impressed with the fact that
the maximum vital energy of woman exists a few days before
the onset of the menstrual flow.
Before drawing the final conclusions suggested by the argu-
ments adduced here, it may be useful to present Dr. Mary Jacobi's
remark on the distinction between sexual and reproduction func-
tion in woman.
There is " a widespread though unconscious perversion
of view that has resulted from the habit of associating menstrua-
tion with the sexual function of women ; and of expecting it to
be accompanied by some especial excitement of the cerebro-spinal
nervous system, such as must necessarily hold in abeyance all
other activity of the central nervous organs.
"The suggestion so frequently made that by means of menstru-
ation celibate women were enabled, to a certain extent, to com-
pensate their celibacy, rests on the slenderest foundations. But
we should assert that the menstrual process, peculiar to the one
class of animals who are capable of avoiding or of missing an
opportunity to propagate their species, indicates that this freedom
of choice is only superficial or apparent, and that the initial steps
of reproduction are being constantly, not periodically, taken by
the force of nature, working independent of human will or of
social accident. The woman buds as surely and as incessantly as
the plant, continually generating not only the reproductive cell,
but the nutritive material without which this would be useless,
whether or no either be utilized in further development" (pp.
166-167).
It is necessary to bear in mind the distinction between sexual
function and reproductive activity from the point of view of
cellular potentiality on the basis of which I have developed the
theory of sex determination. In Dr. Mary Jacobi's own words
this distinction is most apparent, and we know that in human
beings sexual excitability and function is -provided only for the
purpose of making reproduction possible. High sexual excita-
bility, characteristic of abnormal conditions, in no wise corre-
sponds to high cellular potentiality observed during the week
or ten days preceding the menstrual flow. The subject with high
THE GENESIS OF SEX.--D». Ro»inovitch.
29
sexual excitability is far from enjoying a maximum of vital
energy, as she generally is a neurasthenic or belongs to some
other group of degenerates with a reduced cellular potentiality.
Hence, when we speak of vigorous cellular potentiality in its
relation to the resulting sex — when conception takes place during
such a propitious time, that cellular vigor has nothing in common
with the degree of sexual excitability in woman.
Focussing our leading arguments together, therefore, we find
the following propositions :
1. Woman's highest potential energies, during menstrual life,
correspond to a period about ten days, more or less, before the
onset of menstruation.
2. A male child is most apt to be the issue of a conception
taking place at such a period.
3. The Jews, to whom marital intercourse is forbidden during
the period comprised between the last five days preceding and the
seven days following menstruation, give birth to more male than
female children in comparative excess over other nations.
4. In advanced countries the superfluity of women is gradu-
ally dying away.
5. In advanced countries marriages take place at an age corre-
sponding to the height of neuro-muscular vigor.
6. College-bred women marry later in life and marry educated
and professional men ; they give birth to more male children
(55%) than do the non-college-bred women. (45%).
7. The only reasonable interpretation of these facts is that in
advanced countries the level of mentality and neuro-muscular
potentiality of parents is higher than in backward countries,
and that this high potentiality must certainly have a decided
effect on the decrease of female births.
8. If my supposition presented here, regarding the correspond-
ence between the male issues and high cellular potentiality of
the woman at the time of conception is correct, we have a valuable
clue to the study of the genesis of the sexes.
9. If we were to acquire positive knowledge of this correlation,
we should have a valuable means of controlling and directing the
male and female population of the world.
Alarmists should not shrink from the thought of our becoming
enabled to meddle with nature's sex apportionment; civilization
and science gradually lead us into paths of wisdom and subtler
utilities than the enertia of our mentality allows us to fathom.
JO THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i
REFERENCES.
1. V. Magnan. — Recherches sur les Centres Nerveux, 1893,
pp. 145-6, 162.
Louise G. Robinoviteh. — The Genesis of Epilepsy Clinically
Considered. The Pathology, Prophylaxis and Treatment of Epi-
lepsy. Illustrated by Cases and Statistical Tables, The Journal
of Mental Pathology, Vol. II., pp. 24, 83, 140, 187 and 264.
Idiot and Imbecile Children. Various Causes of Idiocy and
Imbecility. Relation of Alcoholism in the Parent to Idiocy and
Imbecility of the Offspring. A Clinical Study, The Journal of
Mental Pathology, Vol. L, Nos. i and 2, 1901.
The Relation of Criminality in the Offspring to Alcoholism of
the Parents, Congress of Psychiatry, Paris, 1900.
On the Duty of the State in the Matter of the Prevention of
the Birth of Crime and of Its Propagation, Journal of Mental
Pathology, Vol. I, No. 3, 1901, and Proceedings of the Fifth
International Congress of Criminal Anthropology, Amsterdam,
Holland, 1901.
2. Dr. Mary Putnam lacobi. — The Question of Rest for
Women During Menstruation, Putnam's Sons, Publishers, New
York. Claude Bernard quoted on p. 82.
3. Prof. Sikorski. — Sexual Continence, The Journal of Mental
Pathology, Vol. VII, No. 4, 1905.
4. The Relative Number of Men and Women, The Journal
of Mental Pathology, Vol. VII, No. 4, 1905.
5. Prof. A. Marro. — La Puberte chez I' Homme et chez la
Femme.
6. Dr. Louise G. Robinoviteh. — Remarks on a Specific Human
Energy and Its Economic and Social Significance, The Journal
of Mental Pathology, Vol. VII, No. 3, 1905.
7. Dr. Hirsch. — Quoted by Dr. Mary Putnam Jacobi, in /. c.,
p. 79.
8. Prof. Augusto Giannelli. — Studii sulla Pazzia nella Provin-
cia di Roma, 1905.
9. Dr. Mary Putnam Jacobi, /. c.
10. Dr. Alfredo Salerni. — Le oscillazioni periodiche mensili
della temperatura, del pulso e del respiro nelle alienate mestruale
e nelle amenorroiche ; Abstract in The Journal of Mental Path-
ology, Vol. VL, Nos. 3-4, p. 99.
, . New York, December, 1905.
The Journal of Mental Pathology
Edited by Louise G. Robinovitch, B. is L., M.D.
Vol. VIII. 1906. No. i
STATE PRESS, Publishers,
New York.
MSS. and Communications should be addressed to the Editor,
28 West 126th Street, New York.
Address bulky mail matter to P. O. Box 1023, New York.
This Journal is published in volumes of five issues each. Price of each
volume, $2.50 per annum. Single copies, 50 cents.
Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope.
A MEDAL FOR DR. MAGNAN.
The colleagues and pupils of Dr. Magnan will present him
with a gold medal on the occasion of his jubilee. One side of the
medal will present, in bas-relief, Dr. Magnan leaning over a
maniacal patient undergoing bed treatment. Dr. Magnan was
the first to institute bed treatment for the maniacal insane in
Paris, — and in France.
Dr. V. V. Vorobiev was shot by one of the militia while he was
attending the wounded during the riots in Moscow, and died im-
mediately.
TRANSLATIONS AND ABSTRACTS OF CURRENT
LITERATURE.
Hygiene in the Russian Prisons. — In a letter to the Muench-
ener Medizinische Wochenschrift, September 18, 1906, Dr. A.
Dworetzky writes from Moscow as follows below:
Prisons in Russia have become a remarkable actuality within
the last year. Since the declaration of the Imperial Manifesto,
October 30, 1905, granting popular suffrage and inviolability of
person, there is hardly any respectable person here who has not
been made to breathe prison air and to taste prison fare. During
32
HYGIENE IN THE RUSSIAN PRISONS.
the past year the number of existing prisons in Russia proved
to be entirely insufficient, and since the declaration of the invio-
lability of person in Russian, the Government, deeply sensible
cf this want, has caused a number of new prisons to be built.
The prisoners who filled these dungeons were a curious collec-
tion of humanity: Professors of colleges, physicians, lawyers,
school teachers, engineers, mechanicians, railway employes, postal
and telegraph operators, editors, journalists, writers, generals,
priests, factory hands, typesetters, clerks, servants and an end-
less variety of other people. Series of delegations of various
societies and unions, students of both sexes, pupils of conserva-
tories, art schools, gymnasias and technical schools, etc., etc.
The chief evil in the sanitary conditions in the Russian prisons,
thanks to the "constitutional" era of Mr. Durnovo and the "lib-
eral" epoch of Mr. Stolypin, is their being terribly overcrowded.
1 do not refer here to the police prisons, overcrowded with all
sorts of "political" offenders, where they are subjected to an
existence unworthy of a human being. In each cell are huddled
together as many persons as it can possibly hold ; when the doors
of such cells are opened, the prisoners tumble out. Under these
circumstances there can be no question of the possibility of sitting
or lying down, and the rare chance of finding standing room
where one may lean against the wall is accepted with a grateful
feeling.
The conditions in the large Government prisons are not much
better. An approximate notion of the overcrowding may be gath-
ered from the official report, according to which, at the end of
April of this year, the Government prison was overcrowded to the
extent of from 60 to 65 per cent, above its normal capacity. In the
Wilna prison, with a capacity for 315 persons, 667 persons were
housed ; the Kovno prison, with accommodations for 447 persons,
held 488 prisoners ; the Kharkoff prison held 748 instead of 371 —
its fullest capacity ; the Pskow prison, 300, instead of 175 ; Chern-
igov, 385, instead of 150; in the St. Petersburg prison, Peter-
Paul, 1,062, instead of 798, etc., etc. The Saratov prison, with
its maximum capacity for 460, was crowded with 1,068 persons.
Chronic overcrowding is not the only unsanitary evil in Rus-
sian prisons, as may be judged from Dr. Ssulima*s letter, de-
scribing the prison "Kresty," built for solitary confinement and
known as the St. Petersburg "model institution," where the Doc-
tor had spent six months previous to being exiled to Archangel.
Dr. Ssulima's letter was published in Russky Vratch, describing
his personal experiences and sufferings of his own flesh while
in that prison. The prison was overcrowded, harboring 1,000
HYGIENE IN THE RUSSIAN PRISONS. ^^
persons — a number far above its normal capacity. As the num-
ber of single cells was far below that of the prisoners, each cell,
built for solitary confinement, was crowded with two and even
three political offenders. The prison fare is, according to Dr.
Ssulima, wholly insufficient and the prisoners are victims of
chronic hunger. Indeed, the allowance per capita, per day, is
from 12 to 14 kopeks — before it goes through the hands of the
administration. The bread, the prisoners' mainstay of food, is
generally raw; during the six months of his confinement in this
prison Dr. Ssulima tasted properly baked bread only twice. The
pale faces and starved appearances of the emaciated bodies of the
prisoners are eloquent and sad witnesses of the insufficiency and
unwholesomeness of the prison food. The air rivals the food in
foulness. Each cell is provided with one zinc, or tin pail, for
use as a water closet; the pail is seldom provided with a suitable
cover. In the morning when these ''contrivances for the produc-
tion of vitiated air" are carried out of the cells, a pestilential
stench is diffused throughout the prison. These pails, when emp-
tied, are brought back to the cells without ever being cleansed.
On hot summer days the presence of these vessels makes the foul-
ness of the air in the cells unbearable. The cells are never ven-
tilated.
Tubercular subjects are mixed indiscriminately with the other
prisoners, and when the daily sweeping of the cells, that are never
disinfected, is practiced, there is added to the usual stench of the
air an infected cloud of dust. A bottle containing a disinfectant
solution may be found in the prison, but the substance is used
only on such exceptional holidays as Easter; a tablespoonful of
the solution is allowed for chosen cells! There can be no ques-
tion of cleanliness as applied to the kitchen.
From the above description one may judge how defective are
the hygienic conditions of prisons that are **model institutions."
The 'Transportation Prison," at Moscow, for instance, is wholly
inadequate as regards hygienic conditions there ; the general cells
are swarming with vermin ; wooden benches are used as beds, and
placed so close together that there is space to pass through only
between every four benches. The windows cannot be opened
and there is no possibility of ventilation except when the window
panes are broken. The asphalted floor is in a dilapidated condi-
tion and the holes in it, filled with dirt, are sources of infection,
whether left dry or sprinkled with water to prevent the raising
of clouds of dust when swept. Tuberculosis is rampant and the
cells resound with the coughing of the tubercular prisoners.
The sick prisoners far prefer to remain in these cells to being
34
HYGIENE IN THE RUSSIAN PRISONS.
transferred to the prison hospital, that is more repugnant in filth
and dirt than the cells themselves; indeed, the hospital is a ver-
itable cesspool.
Such are the conditions of the Main Government prisons ! And
the hygienic status of the provincial prisons may be judged from
a protest presented by the inmates of the Tambov Government
prison to the district attorney of that province:
"... our cell, with a maximum capacity for 20 persons,
is harboring 32 persons; this overcrowding causes a damp and
foul atmosphere in which we are forced to spend 23 >4 out of
every 24 hours; in consequence of the foulness of the air the
stronger of us suffer continuous headaches and the weaker fre-
quently have fainting spells. The undermining of our systems
is made still worse by the absolutely unbearable fare, devoid even
of a minimum of nutritious substances ; the bread is raw and only
serves to provoke gastric derangements. Those who can afford
to have food brought to them from outside are not allowed to
do so, except twice a week. Boiled and fresh drinking water
cannot always be had. The quality of the food and the nauseat-
ing filth in the kitchen where it is prepared, does away with any
desire to partake of the meals. The absence of beds makes it
necessary for us to sleep on the filthy and cold asphalt floor, and
we are exposed to catching all sorts of diseases through exposure
to this filth, cold and dampness. Two of our comrades had to be
transferred to the hospital and three others need hospital treat-
ment. The prison physician has confirmed the existence of these
conditions. Bed linen is an unknown thing here, and the straw
in the mattresses has been reduced to dust from long use. We
are allowed to take a walk only for one-half hour a day, and
the rest of the 23]^ hours we are compelled to spend within the
enclosure of cell walls, where there is no ventilation and the filth
and dust are stifling. The political prisoners are compelled to
empty the night chambers and slop pails . . ."
There are no recreation hours for the prisoners. The dis-
cipline is rigid, and applied by force of club law. The reader
will perhaps ask: "What does the prison physician do about
this? Why does he not recommend the introduction of
indispensable sanitary improvements?" But such a display of
professional concern cost Dr. Fink, of the Tambov prison, his
position. His post was then bestowed on a sort of male nurse..
Such are the conditions in the major prisons. The sanitary
status prevailing in the police prisons may be judged from the
protocol of the Baku province physician. Dr. Alichanov: Sixty-
three men were put into four rooms and all the women prisoners
HYGIENE IN THE RUSSIAN PRISONS. 35
were crowded into one room. The walls in all these rooms were
filthy and covered with expectorated matter; dust and cobwebs
met the glance everywhere, and the air is foul and stifling. The
prisoners lie upon the floor, as there are only eight beds in all
and no benches. The food is extremely unwholesome and insuffi-
cient. The expense per prisoner per day is 12 kopeks, of which
9 are allowed for his bread. The kitchen is dark, rilthy and
utterly inadequate for the purpose. The copperware is in bad
condition and covered with verdigris. There are no cups, glasses
or other appropriate utensils for handling water ; instead are used
discarded tin cans. No baths are allowed the prisoners.
In the reports of the Orel prisons it is stated that they are
terribly overcrowded; the cells are damp, dirty, and in conse-
quence the prisoners are falling victims to various diseases. One
of them. Dr. Ispolatow, was dying.
I could cite a series of other documents and authentic facts
on the sanitary status of the Russian prisons, but I believe that
what has been cited suffices. The reader is sufficiently enlight-
ened as to the conditions under which political prisoners are com-
pelled to exist; their offenses, in the majority of cases, are:
participation in a strike, demonstration or meeting, carrying about
political pamphlets, or at the most a revolver was found at the
offender's home when searched by the police. Many of these
prisoners were arrested simply because they were suspected of
being political offenders, although no evidence was found to jus-
tify the suspicion. Many prisoners are entirely innocent of any
offense and are unable to explain even to themselves the cause
of their arrest and of their doom to remain in prison apparently
indefinitely. Many prisoners, under the stress and strain of the
unbearable prison conditions, become nervous wrecks and often
revolt against the prison officials. Every offense of a prisoner
is promptly followed by punishment, which consists of forbid-
ding him to receive friends, to take the daily walks, to read, to
write, or he may be put in a dark cell, etc. The punishment
meted out is often out of proportion to the offense, and the re-
volt of the prisoners often leads to tragic incidents. Such was
the case when the prisoners of the St. Petersburg Transportation
prison requested the withdrawal of orders forbidding visits of
friends, etc. Their requests were answered by the arrival of the
Seventeenth Battalion of Engineers, who speedily established
order by means of the butt ends of their muskets.
August 18, of this year, a similar incident took place in tEe
Moscow Transport prison, Butyrki ; the prisoners requested an
ii;terview with the Director of the prison, Mr. Stankievitch, in
36 HYGIENE IN THE RUSSIAN PRISONS.
order to complain to him personally about the unedible food.
filth and stifling air in the cells and the unwarranted rigid disci-
pline. The request was not granted. The prisoners then re-
volted openly. They were quickly subdued by two companies
of the Pernov Infantry, who invaded the prison court and cor-
ridors and fired several volleys against the cell windows, killing
two prisoners and wounding fifteen.
The mismanagement of the Russian prisons may be judged
from an incident that occurred in the hospital wing of the Butyrki
prison, March 22, of this year: an explosion of a lamp was fol-
lowed by a fire in the hospital ward, rapidly enveloping the entire
room in flames. The only exit from the barracks was cut off, and
the 28 prisoners, most of them chained at their feet, found them-
selves in the midst of the flames in this room with its iron-barred
windows. When the firemen arrived, the majority of the pris-
oners were unconscious and covered with severe burns. Four
of the prisoners died of the burns received.
It is not to be wondered at that the Russian prisons are sources
and breeding places of various neuroses and infectious diseases.
Indeed, according to a recent report of the Governor of Moscow,
the hospital ward of the prison contained 20 insane prisoners, 14
cases of scorbutis and 11 cases of various infectious diseases
(febris recurrences, erysipelas, measles, etc.). Typhus fever is
particularly prevalent in the transportation prison Butyrki, and
causes a high mortality among the prisoners. In the beginning
of this year, when Mr. Durnovo imprisoned 72,000 persons in
order to save the remnant of the Russian State rights, as he
delicately expressed himself, typhus fever broke out in the Butyrki
prison, causing a marked mortality among the prisoners. The
superintendent of the Zemstvo Hospital for the Insane, at
Mesezezeresk, Dr. Lebedev, was one of those victims. He had
been arrested on suspicion of political unreliability! Wishing-
to have him receive decent medical attendance while he was
stricken with the disease, his friends asked the authorities' per-
mission to have him removed to one of the city hospitals, but the
request was promptly refused. The Zemstvo authorities then
mtervened themselves and finally obtained permission to remove
him, when death had spread its shadows over the hopelessly
stricken man's features. He was transferred to the Sokolniki
Hospital, where he shortly died of the fever.
Nor was the "model institution," Kresty, at St. Petersburg,
spared the visitation of typhus fever. In the early part of this
year a severe epidemic raged among the prisoners. The stricken
patients were transported to the hospital barracks, and friends
MENINGO-ENCErilALITIC IDIOCY. 37
Vvere now readily permitted to visit them! The medical ofiicers
energetically protested against this ill-timed administrative lib-
erality ; in consequence of this protest the women were no longer
allowed to sit on the beds of their stricken husbands, but were
led into the morgue, where they could view the corpses of their
bread winners.
It need hardly be added that in the other prisons of the vast
Russian empire all sorts of epidemics, particularly tubercu-
losis, are firmly rooted. Many of the prisoners are stricken
with melancholia, and insomnia of months' duration is claiming
many victims. Robust persons with well developed nervous sys-
tems and bodies soon break down under the stress of these condi-
tions in the Russian prisons ; and still less do the youths confined
in large numbers fail to break down there. Such was the case, in-
deed, with a 14-year-old school girl, who was confined in the
Butyrski prison ; her health gave way and she sank into melan-
cholia.
What has been said about the life in the Russian prisons suffi-
ciently explains why the proportion of suicides is so enormously
high. I shall confine myself to the description of only three cases
of sucide that are typical of the conditions under which we
exist. A teacher, P. Mjakotin, 29 years old, exasperated by his
condition, cut a sardine box into small pieces and swallowed
about 70 bits of the tin. Within a few days after he lay stricken
with acute peritonitis caused by perforation of the gastro-intes-
tinal tract. Through the irony of fate, a timely laparotomy saved
his life. A youth, Yefimov, was arrested in March, 1905, for some
insignificant political offense, and kept imprisoned for eight
months. By virtue of the amnesty act, he was set free m No-
vember; he was rearrested, however, in December, because he
had taken part in a meeting not authorized officially. He was
kept in prison until April, when he was at last freed again.
Broken down by the sufferings he had gone through, he ended his
life by sending a bullet through his brain. A workingman,
Sadovnizi, undermined by life in the Kharkov prison, ended his
life by cutting his throat, leaving a helpless widow and seven
children.
Such is the hygienic status in the Russian prisons.
Meningo-Encephalitic Idiocy ,^Drs. Riviart and Chardon :
the child was 8 years old, born of an alcoholic father, and first had
convulsive attacks when 5 years old. At that age the patient
was distinctly idiotic, walked with difficulty, was filthy, could
not speak or understand what was said to him, but did not pre-
38
A CASE OF ACROMEGALY.
sent any stigmata of degeneracy. During three years of his so-
journ in the asylum the child's condition remained stationary;
he was oblivious of his surroundings, did not recognize anybody,
but often had spells of anger, bit the children who happened to be
near him and knocked his head against the wall. He finally died
of miliary tuberculosis. Autopsy: adhesion of the dura mater;
edema, congestion and opacity of the pia mater, showing some
scattered tubercular granulations. There were extensive inter-
frontal adhesions, particularly marked and numerous adhesions
in the region of the Sylvian fissure; the brain presented a large
number of irregularly distributed erosions. All these lesions re-
sembled those found in general paralysis with the exception that
there was no atrophy. The lateral ventricles were normal. Nu-
merous tubercular granulations were found in all the organs. The
case was one of meningo-encephalitic idiocy (Gazette des
Hopitatix de Toulouse, Nov. 25, 1905).
A Case of Acromegaly. — Dr. Heilporn: the patient first
noticed his trouble about three years ago, following heavy ex-
cesses in alcoholic drinks. His heredity is negative, but he
has syphilitic ulcerations and diabetes with accompanying poly-
uria, glycosuria, etc. An X-ray examination shows enlargement
in all its diameters of the sella turcica, having a double contour
probably due to calcification of the periphery of the pituitary
body. The frontal sinuses are of enormous dimensions. There
is osteoporosis of the bones of the forearms, the articular spaces
are considerably enlarged, there are exostoses on the fingers
and deformities of the elbows and knee joints {Journal de Neu-
rologie, Nov. 5, 1905).
A Case of Attack by Habit. — Dr. Crocq : a girl, 12 years of
age, was in a habit of having an epileptiform attack every week,
on Friday night. The author considered the trouble as being of
hysterical nature, and gave the patient a hypodermic injection of
artificial serum. The child had had no attacks for two months fol-
lowing the day when the injection was made. The remedy acted
as an indirect suggestion {Journal de Neurologie, Oct., 1905).
Forms of Dementia Precox. — Drs. E. Marandon de
MoNTYEL AND L. MoNGERi I Dr. Mougeri criticises Dr. Marandon
de Montyel's views on dementia precox. Dr. Marandon de Mont-
yel looks on dementia precox as on a variety of the psychoses of
the degenerate, saying that dementia precox is neither a dementia
nor precocious. He adduces reasons in support of this declara-
tion. Dr. Mongeri believes that dementia precox is a psychiatric
THE PARIS POPULATION. 39
entity, and he presents a lively cricicism in support of Kraepelin's
dementia precox (Annales Medico-Psychologiques, No. 2, 1905).
The Paris Population.— Dr. Lowenthal : the number of mar-
riages is small in Paris, there being only 71.2 married men to each
1,000 unmarried ones (single, widowed and divorced), as against
85 per 1,000 in Berlin; among women there are 43.4 married
against 48.5 in Berlin. Tardy marriages, and consequently child-
less, are more numerous in Paris — 46.5 women over 50 years of
age, against 26.4 of similar age in Berlin. The death rate from
typhoid fever, smallpox, puerperal fever and tuberculosis is much
higher in Paris than in Berlin. The average death rate for the
period 1898-1902 per 10,000 inhabitants in Paris and Berlin re-
spectively is as follows: the mortality from typhoid fever was
475 per cent, less in Berlin than in Paris ; the mortality from small-
pox, 15.550 per cent, less in Berlin than in Paris; the mortality
from puerperal fever — about equal in both cities ; mortality from
tuberculosis — 90 per cent, less in Paris than in Berlin. Neverthe-
less the latter mortality is high in Paris, and the non-enforcement
of the law of public sanitation is responsible for this high mor-
tality (Progres Medical, Nov. 25, 1905).
Criminality in England. — The Annual Report of the Commis-
sioners of Prisons shows the following results : the number of se-
rious or indictable crimes per 100,000 inhabitants has fallen from
37 in 1880- 1 to 25.9 for the year under report. Summary offenses,
on the contrary, have increased from 542.8 to 560.3 per 100,000
inhabitants. THe number of commitments per 100,000 population
for the last quarter of a century varied from the highest (621.6)
in 1882-3, to the lowest (460,7) in 1 900-1. Since 1 900-1 there
has been a progressive rise, culminating in 586.2 for the year
1904, the number being the highest since 1884-5. The rise, how-
ever, has been almost entirely in offenses tried summarily : drunk-
enness, 1,951 ; begging, sleeping out and misbehavior by paupers,
3,669; offenses against police regulations, 1,605, that include
sleeping out and begging.
Decreasing Number of iledical Students Here and in
Europe.— According to the Gazette des Hopitaux de Toulouse,
Nov. 25, 1905, the United States is not the only country in which
the number of medical students is markedly decreased at present ;
Germany and France have experienced similar decreases. In t\\t
United States, in 1904, there were 28,142 medical students,
whereas this year, 1905, there are only 26,12,7 students. The
homeopathic schools have suffered the most marked losses: in
40 BODY WEIGHT AND THAT OF CENTRAL NERVOUS SYSTEM.
1900, there were 1,509 students as against 1,104 ^^ i905- ^^ Ger-
many the total number of students progressively increased from
2,054 to 8,513 during the period 1858- 1888. This number rapidly
decreased and in 1903, there were only 6,232 students. In 1895,
the number of medical students in France was 7,779, while in 1905
there were only 6,763.
The Effect of the Bearing of Young Upon the Body Weight
and the Weight of the Central Nervous System of the Female
White Rat. — John B. Watson : the effect of the bearing of
young is to render the mated rats slightly heavier than the un-
mated, some of the excessive weight being due to the large
amount of fat present in the mated animals. The proportional
brain weight is not appreciably affected, but the spinal cord is
distinctly heavier in the mated series, thus making the central
nervous system as a whole heavier. The percentage of water in
both the brain and spinal cord is in nine cases out of ten greater
in the mated groups. This is perhaps the most important dif-
ference established by the investigation, but the interpretation
must await a further study of the diminution of the percentage
of water in the central nervous system with advancing age and
the conditions that probably modify it ( The Journal of Compara-
tive Neurology and Psychology, Nov., 1905).
Eschars in General Paralysis. — Dr. A. Vigouroux: some
eschars are due to prolonged pressure or neglected nursing ; there
are other eschars, however, due to central and peripheral lesions
of the nervous system — myelites and neurites, accompanied by
epileptiform and apoplectiform attacks, that can only be alle-
viated, but not prevented by nursing. From a medico-legal point
of view the fact is of importance: physicians and attendants
should not be accused of negligence when eschars due to organic
lesions of the nervous system afflict a general paralytic (Revue
de Psychiatric, Oct., 1905).
Speech Training as a Factor in the Development ol the
Feeble Mind. — Dr. G. Hudson-Makuen : defective speech of the
feeble minded constitutes an important hindrance in obtaining an
education; the difficulty in expressing their thoughts leads the
feeble minded to laziness in thought and consequent mental degra-
dation. Speech and thought go hand in hand, as, according to Max
Muller, "to think is to speak low, and to speak is to think aloud."
The training of speech should occupy an important place in the
curriculum of schools for the feeble minded (American Medicine,
Dec. 2, 1905).
FAMILY PATRONAGE OF INSANE AT KHERSON. 41
Infanticide. Anatomical and Clinical Contribution.— Dr.
G. MoNDio: fifty-six cases of infanticide are studied and the
brains of six of the subjects are presented. According to the
author, anomahes of cerebral morphology existed in the six cases.
Cranial anomalies existed in many of the 56 cases recorded (//
Manicomio, No. i, 1905).
Two Years of Family Patronage of the !nsan@, Department
of Kherson. — Dr. Jakovenko : the cost has been 47.2 kopeks per
capita per day, as against 92.5 kopeks in the central hospital,
75.8 kopeks in the farming colony and 52.3 kopeks in the chronic
wards {Journal Nevropatologii i Psichiatrii Imeni Korsakova,
No. 2, 1905).
Why Do Certain Deaf-and-Dumb Subjects Hear Low
Pitched Notes Better than High Pitched Ones? — M. Marage:
This peculiar inversion of hearing is due to a tactile, not an audi-
tory mechanism. Experiments on worms lead the author to the
above conclusion (Progres Medical, Nov. 25, 1905).
Cerebral Hereditary Syphilis.— Dr. William J. Butler : twa
cases of children, 23 months and 6 years old respectively, are cited,
typically illustrating the disease (American Medicine^ Dec. 9,
1905)-
Lombroso's Jubilee. — Professor Lombroso's Jubilee was cele-
brated last Spring in Turin, Italy, in joint session with the Vlth
International Congress of Criminal Anthropology. A series of
works were presented by leading psychiatrists pointing out the
progress wrought by the Lombroso school of criminology.
BOOK REVIEWS.
La Question Sexuelle Exposee aux Adultes Cultives. — Prof.
AuGusTE FoREL. G. Stcinhcil, Paris, publisher. The sexual
question is considered from the scientific, ethnologic, pathologic
and social points of view. Sexual function and love of man, like
that of all other living beings, exists for the purpose of continu-
ing the human species. Hence this question should be treated of
from the standpoint of natural sciences, physiology, psychology
and sociology. Happiness of man requires that human reproduc-
tion be accompanied by progress in the development of the mental
and physical faculties, from the standpoint of health, sentiments,
intelligence, will power, creative imagination, love of useful occu-
42
BOOK REVIEWS.
pation and sentiment of social solidarity. Therefore, every at-
tempt made at solving the sexual question should be directed
toward furthering the happiness of our descendants. The work
treats of the natural history, physiology and psychology of sexual
life, its pathology and its social role. Although scientific, this
chapter is presented in a popular form — for cultured adults, as the
author has it, but which could readily be understood by the aver-
age American youth. The chapter on the sexual appetite in man,
including the sub-titles on puberty, nocturnal pollutions, mastur-
bation, continence, etc., should be read by every youth. Sexual
continence is compatible with good health in man. Far more
abnormal than continence are the numerous artificial and pre-
cocious sexual excitations that we owe to civilization. Being
forced to remain ignorant on the question of sex from the scien-
tific point of view, the youth takes the path of sexual excesses
because he is afraid of being ridiculed by his comrades if he did
otherwise. The term flirt is not equivalent with coquettishness,
but is a polymorphous word expressing clearly a sexual desire,
although the sexual act is not accomplished. Promiscuousness
in sexual relations has really never existed because woman is
strongly monogamic and both sexes are jealous ; but the customs
according to which the priest had the right to connubial relations
with the bride on the night of her marriage, or a distinguished
guest was privileged to dishonor his host's daughter, have a dif-
ferent origin : they were the remains of the customs of privileged
individuality or classes. Among savages celibacy is abhored;
among some civilized peoples celibacy was so much scorned that
when children died young their spirits were married. The Greeks
imposed punishment on bachelors, and the Romans imposed heavy
taxes on them. Our civilization is responsible for increased and
increasing celibacy, economic conditions being the major cause
of the evil. The cult of virginity was the outcome of an errone-
ous notion that there was something shameful in the sexual act.
(Vestals, in Rome; Buddha's mother, who conceived her off-
spring in a supernatural manner, was declared to be a saint and
immaculate, and other similar legends among other nations.)
Kindness and consideration toward the wife is the product of
civilization; in China it is fashionable to beat one's wife; and if
one treats her with consideration it is for the purpose of avoiding
the necessity of purchasing another. The Arab understands
under the term love simply sexual appetite; the ancient Greeks
had a similar notion. Among birds the duration of marriage is
for life, among mammalia seldom more than one year, but
monkeys and man make exception to this rule. The chapter on
BOOK REVIEWS. 43
pathology of sex is instructive, and should particularly prove of
benefit to our jurists. Speaking of sodomy, the author remarks
that an examination of some of the cases of sodomy, in which the
culprits had been condemned to imprisonment for years, leads
him to affirm that the true culprit was not the poor prisoner, but
the judge who had committed him to prison: abnormal relations
cf man with a cow, for instance, has no consequences for the
cow, and does not expose the culprit to syphilis. He relates a
case of a Mohammedan, who had been sentenced to imprison-
ment for such a deed on a goat that belonged to him ; the Moham-
medan accepted the inevitable, but said that he could not under-
stand the logic of such justice. "Nor do I," the author adds.
The question of prostitution is one of struggle for existence in
the majority of women. Anent marriage of convenience,
the author says that formerly one bought his wife and sold his
daughter, while today one sells himself to his wife and buys a
son-in-law. Religion and sexual life is an interesting chapter
soundly presented. Another practical and useful chapter is that
dealing with sexual education in schools for youths.
The volume contains 604 pages in large octavo, and is most
instructive — not only for cultured adults, but for all who can
understand it. Indeed the author deserves to be highly compli-
mented on this work: his long experience as a psychiatrist and
social reformer has particularly fitted him for the difficult task
he has taken upon himself in presenting this complex and compli-
cated subject. He is thoroughly familiar with the physical life
of man and knows that many a family is ruined today because of
man's natural polygamic tendency, or rather because his aversion
to monotony in conjugal relations forces him into polygamy. The
author proposes, therefore, a reform that would radically change
this condition, namely, — free marriages or legal polygamy; also
legal polyandry for those women whose natures require poly-
andry. Whatever merit or demerit attaches to this proposition
every reader will judge for himself. It is only fair to remark,
however, that the main bulk of the question is masterfully handled
in this volume, although some details are at variance with accepted
notions of society.
The price of the volume is 10 francs.
Die Simulation von Qeisteskranlclieit. Mit einem Aniimng:
Die Qeisteslcranklieit in den Qefaengnissen. — By Professor P.
Penta. Translated by Dr. Rudolf Ganter. Published by A.
Stuber, Wurzburg. Price 4 marks 50. The author has studied
44
BOOK REVIEWS.
simulation of mental diseases especially among prisoners in
Naples. Most frequently those subjects simulate dementia with
stupor, refusing to eat or to speak. Maniacal conditions are also
simulated; some subjects present alternating melancholia with
mutism and maniacal excitation. In some instances the simulated
disease lasts for two or more years. The determination to de-
ceive the physician is so marked in some cases of matism that
the application of red hot iron to the flesh of the simulator fails
to provoke the slightest protest from him. The author has
handled such cases; and others of his cases of mutism with re-
fusal to take nourishment, although recognized as those of simula-
tion, had to be fed artificially for long periods of time : they would
have died of starvation had they not been fed artificially. Most
cf the cases related have been handled by the author, and in al-
most all the instances the subjects had confessed to having simu-
lated. From his vast experience with simulators of mental dis-
eases the author concludes that simulation is an indication of ab-
normal mentality and impending insanity. According to his ex-
perience, the majority of such simulators become insane some
time after the spell of simulation. This peculiar mental attitude,
he says, is more or less of a photograph of the mental status in the
near future; the subject is abnormal and his simulation is a fore-
runner of his technical insanity. On the other hand, there are the
technical insane who are skilled simulators as well as dissimula-
tors. Insanity in relation to criminality is considered at length.
The volume is most instructive not only for prison physicians but
for all physicians who handle the insane ; it is most important to
know how to recognize a simulator of mental affections.
L*Anie et le Systeme Nerveux. Hygiene et Pathologic.— *
By AuGUSTE FoREL, ex-Professor of Psychiatry, University of
Zurich, 8-vo, 340 pages, with ten illustrations and 2 colored
plates.- Price 10 francs. G. Steinheil, Paris, publisher. The
soul and the activity of the brain are one and the same thing.
Up to the present time no one has demonstrated the truth of the
hypothesis of dualism, or the existence of a soul without a brain
and vice versa; but every observer may demonstrate to himself
that there is no such thing as soul without a brain or a brain
without a soul. These statements are developed on the basis of
psychology and psychiatry, respectively. As the normality of the
soul depends on that of the nervous system, the author points out
the importance of general and special hygiene of the nervous sys-
tem. The question of education is a most important one in the
matter of maintaining proper hygiene of this system. The arti-
BOOK REVIEWS. 45
ficiality of our general system of education is pointed out and a
more rational one is suggested. The question of public hygiene
comprises a more rational treatment of the criminal, insane crimi-
nal, insane, degenerate, alcoholists, etc. The author would pro-
hibit the use of alcohol even in private sanitaria: the struggle
against popular alcoholism should be kept up vigorously, and
colonies for the treatment of nervous invalids should be multiplied.
Procreation should be regulated on a rational or scientific basis.
This neo-Malthusianism should be established not for the pur-
pose of decreasing the birth rate but for that of increasing the
number of useful and normal beings. The public should amelio-
rate the conditions obtaining in crowded tenements and fight for
pure food. Universities should make it obligatory for students,
especially those engaged in the study of medicine and law, to
familiarize themselves with the principal elementary notions on
psychology and the natural evolution of human beings. The study
of nature should be given a prominent place in the curriculum of
schools for children.
Experimentation sur la Prophylaxie de la Syphilis. These de
Paris, 1906. — Dr. Paul Maisonneuve. Inspired by M. Metch-
iiikoff and Roux's experiments on the abortive treatment of
Ireshly inoculated syphilis in monkeys, Dr. Paul Maisonneuve, of
Nantes, submitted himself to an inoculation with syphilis and the
abortive treatment. He was the first man to submit himself to
this experiment. A thorough examination by leading experts on
syphilis endorsed his statement that he was free from hereditary
or acquired syphilis. He was inoculated with the virus obtained
from two different active chancres, each virus being injected into
a separate area on each side of the middle line of the penis. One
hour after this operation the wounds were thoroughly rubbed
during 5 minutes with mercurial ointment (calomel, 10 grams,
lanolin, 30 grams). The results were negative as regards the
infection. Four monkeys were inoculated with the same virus.
Two of these were treated with the same mercurial ointment : one
an hour and the other 24 hours after the inoculation. The first
remained free from infection, while the second developed typical
secondary lesions. The two which had not been treated developed
typical syphilitic infection. The author concludes that syphilitic
inoculation treated with mercurial ointment within an hour after
the accident is not followed by infection. He considers the efficacy
of this method of considerable practical value in the prophylaxis
>of syphilis.
46
BOOK REVIEWS.
Christianity and 5ex Problems. — Hugh Northcote, M. A.
Crown octavo, 257 pages. F. A. Davis Company, publishers.
Price $2.00. The author is not a physician, not famiHar with
anatomy and physiology and states himself that he cannot con-
sider the question of sex from a scientific point of view. He be-
lieves, however, that "in Christian religion is found the key to
the problems of life." His arguments are based mainly on scrip-
tural quotations. With this scope before him the author presents
a number of chapters, some of which treat of Sexuality in child-
hood, sexual perversion, the sexual act, continence, intercourse
during pregnancy, "frigidity," nocturnal pollution, etc., etc. Such
subjects cannot be presented to the public in a useful form with-
out the author's thorough familiarity with medical matters, in-
cluding a thorough knowledge of anatomy, physiology and
psychiatry. When an author devoid of these qualifications, and
armed only with some biblical knowledge, undertakes to treat of
these difficult problems, the question suggests itself: of what
practical use is such a volume, particularly when eminent psy-
chiatrists and scientists have presented their volumes on the
question of sex?
Tlie Subconscious. — By Joseph Jastrow, Professor of Psy-
chology, University of Wisconsin. Houghton, Mifflin and Co.,
publishers. Price $2.50. Part I of the work treats of normal and
part II, of abnormal psychology. Both parts present the practical
side of the question, and part III of the work is theoretical. The
author deserves credit for the clear manner of presentation of this
subject. In clear and pleasing English and almost popular ter-
minology he handles his subject with the simplicity of a clinician-
psychiatrist. The subconscious is considered in its role during
the various stages : normal wakefulness, dreams as well as during
the various abnormal states of hypnosis and somnambulism. A
remarkably fine collection of clinical cases illustrate the chapters
in a simple and dignified manner. The consideration of the rela-
tion between the conscious and subconscious is of considerable
interest and scientific significance. The subconscious is a study
of recent date, properly speaking, beginning with the progress in
dinical psychiatry. And Professor Jastrow is to be congratulated
on the sincerity and scientific manner in which he has handled
the subject in this volume.
Contribution a I'etude de la necrophilie, L'affaire Ardisson.
— By Drs. Michel Belletrud and M. Edmond Mercier, of the
Hospital for the Insane, Pierrefeu (Var.) Published by G. Stein-
BOOK REVIEWS. 47
heil, Paris. The entire little volume of 123 pages and seven plates
is devoted to the study of a case of necrophilia, or the "Affaire
Ardisson," as it is known in Muy (Var). The subject considered
here is a young man, 33 years old, a grave-digger by occupation,
who found it quite natural to defile the female corpses in the
cemetery in which he was employed. He generally committed
these acts at night and escaped being detected for a number of
years; he was finally arrested because the body of one little girl
and the head of another were found in his room in a state of
advanced putrefaction. Ardisson explained that he had disin-
terred the body and head, brought them home and performed his
vile practices on them for many days. He was adjudged insane
and transferred to the Pierrefeu Hospital for the Insane. A de-
tailed study of this remarkable case is presented in this small
volume. The book is not for sale.
Qehirn und Rueckenmark. Leitfaden fuer das Studium der
riorphologieundder Paserverlaufs. Mlt 122 zum Tell larbigen
Textabblldungen.— By Dr. Emil Villiger^ Privat-Doceiit, Uni-
versity of Basel. Published by Wilhelm Engelmann, Leipzig.
The first part of this work treats of the morphology and embry-
ology of the nervous system; the second — of the course of the
fibres of the cerebro-spinal system. The entire work contains 187
pages, of which a helpful index takes up ten pages. There are
few pages that do not contain one or more illustrations, some of
which are colored. Of the newest works on the normal cerebro-
spinal system this is certainly one of the best and handiest because
it is concise, yet the most difficult details in the study are gener-
ously illustrated in a comprehensive manner. Every student in-
terested in the nervous system will find this a helpful volume.
Die Leukocyten als Parasiten der WIrbeltlere. EIn Beitra;
zur wissenschaltlichen Weltanschauung nach einem Vortrage
auf der 76. Versammlung deutscher Naturforscherund Aerzte
In Breslau, September 2:^, 1904. — By Dr. Johannes Haedicke.
Published by Fr. Schaeffer and Co., Landsberg a. W. The leu-
kocytes are considered from various points of view : in relation to
biology, hematology, pathology, dyscrasia, leukemia, essential
lymphocytitis, septic pyemia, the infectious diseases, the relation
to internal secretions and to many other conditions revealed in the
present day literature on the subject. It is a monograph of 166
pages in octavo of most interesting reading on the subject of
which it treats.
48 BOOK REVIEWS.
Enigmas ol Psychical Research. — By James H. Hyslop, for-
merly Professor at Columbia University. Published by Herbert
T. Turner and Co. 427 pages in small octavo. The work con-
tains chapters on the residues of science, the ancient oracles, crys-
tal vision, crystal gazing and experiments on the same, telepathy,
dreams, apparitions, clairvoyance, premonitions, mediumistic
phenomena, retrospect and vaticination. As the headings of the
chapters suggest, the subject treated of in this work does not
lend itself to any scientific consideration. In his plea for the
study of the subjects indicated, the author says that he does not
impose the absolute belief in premonitions, foresight, etc., but
urges a further study of the matter that seems to him to be sig-
nificant. Many cases of premonition, foresight, etc., are related.
Lectures on Clinical Psychiatry. — By Emil Kraepelin, Pro-
fessor of Psychiatry in the University of Munich. Authorized
Translation from the Second German Edition. Revised and
edited by Thomas Johnstone^ M.D., Edin., M.R.C.P., Lond.
Member of the Medico -Psychological Association of Great Britain
and Ireland. Second Edition. William Wood and Co., Publish-
ers, New York, 1906. Kraepelin's school is so well known to the
psychiatric world that it is hardly necessary to make any com-
ments on the contents of the work. The translation is creditably
made by a psychiatrist of high standing, and will be profitably
perused by those who prefer to read Kraepelin's works in the
English language. The neatness of the edition is characteristic
of the work turned out by Wm. Wood & Co.
Alfektlvitaet, Sugrgrestlbllitaet, Paranoia. — By Professor E.
Bleuler, of Zurich. 8-vo, 144 pages. Price 3 marks. Carl
Marhold, publisher. The work is divided into three parts: 1,
the consideration of the affective sphere, 2 — suggestibility and
3 — paranoia. The chapter treating of the affective sentiment is
most interesting. Throughout the work the author tries to bring
out the relation existing between the affective sentiment, suggesti-
bility and mental aberration. Professor Bleuler is to be congratu-
lated on the happy manner in which he handles this difficult
subject.
Primer of Psycholocry and Mental Disease By C. B. Burr,
M.D. Published by F. A. Davis Co. Psychology, psychiatry and
the treatment of mental diseases are touched upon in this com-
pendium.
The Journal of Mental Pathology
Vol. VIII 1907 No. 2
SOFTENING OF THE GENU CORPORIS
CALLOSl.
By Dr. A. Giannelli^ Docent, University of Rome, Italy, Chief
Physician and Pathologist, Hospital for the Insane, Rome.
(From the Anatomo-Pathological Laboratory ; Director, Prof.
G. Mingazzini.)
The symptomatology caused by lesions of the corpus callosum
has been studied lately especially in connection with tumors that
had caused more or less complete destruction of that region. This
symptomatologic study is not yet complete, however: there is a
divergence of opinion not only in the interpretation of these symp-
toms but also as regards the existence of some of them in relation
with given lesions of this region. It seems to me that as regards
the divergence of opinion on the nosography accompanying lesions
of the corpus callosum, one may repeat what Nothnagel said on
the variation of the symptomatology accompanying lesions of the
corpora quadrigemina : the variation is due to the dire lack of
comparative studies of cases with destructive lesions (circum-
scribed, focal, hemorrhagic or softening).
The case presented here is one of a lesion of the genu corporis
callosi caused by white softening.
The patient, T. S. R., 55 years of age, married, laundress, was
admitted to the Hospital for Insane, at Rome, February 2, 1905.
Her early history cannot be had. She contracted syphilis some
years ago and had had two abortions. She did not remember the
date of these abortions and said that she had not received any
treatment for the syphilitic infection.
50 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
Objective Examination. — On admission to the hospital:
frame and muscles well developed; complexion dark, hair rather
thin; paramammary lymphatic glands felt on palpation; tibial
ridge knotty; respiration normal, pulse slow and hard; Huch-
ard's symptom : second aortic sound exaggerated ; naso-labial fold
more marked on the right side when the patient bared her teeth ;
she could not protrude her tongue completely; motility of the
upper and lower limbs normal; no resistance to passive move-
ments; muscular force quite below the normal, tactile, thermic
and dolorific sensibility equal on both sides of the body; right
knee reflex more marked on the left side ; pupils of medium size,
regular, reacted slowly to light.
Attention easily distracted: marked impairment of memory
both for recent and remote events. Notion of time and place con-
fuse. No delusions. Incoherence of speech. Aimless repetition
of the same words and phrases several times in succession. At
times — repetition of words or phrases said before her (echolalia).
Affective sphere impaired, the patient showing no interest in any
members of her family. No desire for anything. Frequent spells
of laughing without any provocation.
November 20, 1906. — The patient was suddenly stricken with
an apoplectiform attack while sitting in the garden. Her face,
neck and ears suddenly reddened in the order mentioned; she
made several attempts at vomiting and then fell. Two attendants
came to her aid and led her into the ward, where they put her to
bed. The patient's left foot dragged on the ground as she was
being led by the attendants. According to the attendants, her left
upper limb was also paralyzed when she was lifted up from the
ground, and when the hold on her arm was withdrawn, it fell,
making some oscillatory movements, to the side of the patient's
body.
When examined on the following morning the patient was lying
on her left side, her head turned to the right ; the direction of the
eyes seemed to be normal; the face was reddish and the skin of
the face was smooth, without any. deep lines; the eyes were open
and both upper eye lids at the same level ; the naso-labial lines
were markedly effaced on both sides. The patient opened her
mouth with much difficulty and succeeded in protruding her
tongue only slightly ; the tongue was deviated to one side. Deglu-
tition of liquids was normal but she could not swallow solid food.
The left extremities were paralyzed and presented marked resist-
ance to passive movements. The lower right extremity could be
moved only slightly and with great difficulty. Voluntary move-
tnents of the right upper extremity were also slow and limited,
SOFTENING, GENU CORPORIS CALLOSI.— A. Giannelli. 51
and it was impossible to lift it above the horizontal line. There
was also marked resistance to passive movements. Tactile, do-
lorific and thermic sensibility normal in so far as could be judged
from the motions of reaction to pain. She screamed when pricked
with a needle but made no attempt to ward off the stimulus that
caused the pain, nor did she carry the right hand to the region
pricked.
The knee reflexes were marked on both sides; the tendon
Achillis reflex could not be obtained; Babinski's and abdominal
reflex were absent. The pupils were unequal (the left one being
the larger), rather dilated and did not react to light.
The patient did not speak and it was difficult to know whether
she understood what was being said to her. Her face was expres-
sionless and she stared in a fixed manner. She did not partake
of any food put before her, but swallowed it when put into her
mouth.
Bed sores in the sacral region developed two days after she had
been put to bed, although all precautions had been taken to pre-
vent the trouble. In a few days the ulcer extended to the bones,
was black and measured about five centimetres in diameter.
A few days later resistance to passive movements was still more
accentuated and muscular movement of the right upper extremity
was still more limited.
December 6, 1906. — The patient remained in bed on her back,
her head turned to the left, the eyes looking with a fixed stare.
Expressionless face, no matter what was said to her. The eye
muscles seemed to be normal. The lower extremities were flexed
at the hip and knee joints and both feet turned outward. Marked
resistance to passive movements in the entire body. Pressure on
the foot and leg was followed by pallor of the parts that disap-
peared after a certain time. The left forearm was flexed at a
right angle at the elbow, the hand flexed at the wrist and closed in
a fist, the whole limb being held close to the body. Passive move-
ment was resisted with great force in this limb. The right upper
extremity was held close to the body most of the time and its vol-
untary movements were limited. At times this limb was flexed at
the elbow and wrist, the hand resting on the chest. Resistance to
passive movements was less marked in this than in the left limb.
After considerable insistance the patient was made to open
her mouth : she remained with her mouth open about a minute.
The naso-labial lines were effaced on both sides while the mouth
was open; the tongue was tremulous in the buccal cavity. The
head resisted to passive movements in the direction of its three
axes of rotation. Impossible to make her sit up in bed on account
52 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
of resistance to flexion and extension at the various joints. Prick-
ing with a needle and touching her with hot objects made her cry
out, but she made no defensive movements, not even with the right
upper extremity. The pupils were still unequal and did not react
to light. Absence of abdominal and Babinski's reflexes on both
sides. Pharyngeal reflex normal. Tendon reflexes of upper
limbs exaggerated. Fecal and urinary incontinence. Commenc-
ing bed sores at the points of the inner trochanters of the femur
and fibulae. This was preceded by blisters filled with yellowish
effusion. The rupture of the blisters was rapidly followed by deep
ulceration at first dark red and then black in color. The pulse
was rapid and often irregular, respiration superficial and inter-
rupted by irregular pauses. No rise of temperature at any time.
This condition continued until death took place, December 13,
1906.
Autopsy. — Autopsy made 24 hours after death. Dura mater
normal. Pia mater normal in color and thickness and tore off
easily from the cerebral substance. Both frontal convolutions
smaller than normal; their configuration and consistency normal.
Development and configuration of the rest of the convolutions
also normal. Right hemisphere decidedly smaller than the left
one, difierence between their maximum diameters about i centi-
metre. On pulling asunder the hemispheres, the anterior end of
the corpus callosum presented a creamy mass for a stretch of ij4
centimetres. The softening comprised the whole genu corporis
callosi and rostrum. The gyrus fornicatus (callosal gyrus-Huxly,
premiere circonvolution limbique-Broca) was of normal form,
color and consistency. A transverse cut made in front of the
genu corporis callosi and cornu anterior of the lateral ventricles
showed nothing abnormal. Another cut passing through the
anterior end of the corpus callosum showed a soft mass of matter
instead of the fibres; this mass had a sharp line of demarkation a
few millimetres from the inner side of the ventricular ependyma
without encroaching on the fibres turning on the cornu anterior.
In the plane of a cut passing immediately behind the tuber olfac-
torium, through the anterior end of the corpus striatum, the
softening of the corpus callosum did not exist.
The cavity of the cornu anterior was well defined on both sides.
The volume, shape and consistency of the nucleus caudatus and
putamen and the colliculus nuclei caudati were normal.
A cut passing behind the median part of the commissura ante-
rior and crura antcriora fornicis showed a lesion of old standing
(in the uppermost part of the right putamen which encroaches
somewhat on nervous tracts of the upper part of the crus anterior
SOFTENING, GENU CORPORIS CALLOSI.— A. Giannelli. 53
capsules int ernes) ; the diameter of this lesion was from 4 to 5
milHmetres, extending antero-posteriorly from 5 to 6 millimetres.
The corpus callosum and the rest of the nervous elements were of
normal aspect and consistency.
Summary. — Patient, a woman, 55 years of age. Remote history
could not be had. Marked risus spasticus. Two years after the
onset of this trouble she suddenly fell in an apoplectiform fit. This
was followed by aphasia and tetraparalysis (left hemiplegia, par-
alysis of the lower right and paresis of the upper right extrem-
ities). The autopsy showed the existence of an old lesion in the
uppermost part of the right putamen and crus anterior capsula
interna:, and a recent lesion — white softening of the genu corporis
callosi.
There can be no doubt that the symptom of risus spasticus of
old standing was correlated with the old lesion ; while the motor
disturbances following the apoplectiform attack, within the last
23 days of the patient's life, were in relation with the white soft-
ening of the genu corporis callosi.
After Nothnagel and Bechterew's demonstration of the exist-
ence of a mimic centre in the optic thalamus, many observers
(Fere, Rummo, Crocq, Brissaud, Mingazzini, Franceschi, Gian-
nuli, Giannelli) published papers on spasmodic laughing and cry-
ing. Recently, Giannelli pointed out that it was important to class
separately cases with risus spasticus only and those of spasmodic
crying only : reviewing these "pure" forms, as he terms them, he
found that five out of eight cases presented, besides the lesions
commonly found in combined spasmodic laughing and crying, a
lesion of the crus anterior capusulce internee.
The data published in one of my recent cases agree with these
conclusions. The case was one of a woman of advanced age.
After an apoplectiform attack she presented a profound change
of countenance: the slightest provocation made her laugh; most
usual acts of every day life made her laugh; the various acts of
dressing and undressing herself or of eating, etc., made her laugh,
the laughing being accompanied at times by loud outbursts of un-
controllable laughter. The autopsy revealed the existence of a
single, well-defined lesion in the most anterior and upper part of
the right putamen, in the region limited above and the inner side
by the putamen itself, involving at the same time the limitrophic
nervous centres situated in the crus anterior capsules internee.
The case forming the subject of this paper is similar to the one
just recorded : the patient had involuntary and frequent laughing
spells that took place without any provocation. In this, like in the
other case, the autopsy revealed the presence of a small lesion of
54 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
old standing in the crus anterior capsules internee and in the most
anterior and superior part of the putamen.
The seat and extent of this focal lesion of old standing shows
that the tracts whose lesion is followed by spasmodic laughing
pass through the upper and anterior part of the crus anterior cap-
sules internee and the anterior and upper part of the putamen.
The motor paralysis from which the patient suffered during the
last twenty days of her life, following a slight apoplectiform at-
tack, was caused, as has already been remarked, by white soften-
ing of the genu corporis c alio si.
In the literature at my disposal I have found recorded only two
cases of softening of the corpus callosum : the first one was pub-
lished many years ago by Kaufmann ; the second, in 1902, — by P.
Marie and G. Guillain.
Kaufmann's case. — A man, 45 years of age, suffering from pul-
monitis, with meningeal symptoms, was brought to the clinic in a
moribund condition and died there the night after his admission.
According to the patient's history, he was well mentally. Au-
topsy : tumor of the right lung, myocarditis and nephritis. In the
brain: thickening of the pia mater at the convexity, some parts
being edematous and others infiltrated with pus. Similar and
even more marked condition at the base of the brain. At the
point where the arteria cumunicans anterior starts from the ar-
teria corporis callosi dextra there was an aneurism, the size of a
cherry stone, containing a thrombus. Both olfactory tracts were
yellow-brownish in color; of a similar color were the surfaces of
the following regions in both hemispheres : first and second fron-
tal, median and dorsal sides of the first frontal ; on the right side
■ — dorsal side of the second frontal, the genu corporis callosi — the
only part of the corpus callosum that could be distinguished from
the rest — was also of a yellow-brownish color. That part of the
convolution of the corpus callosum, on the right, which turns
in front of the genu was of a hob nail appearance and shrunken ;
behind it was distinguishable only up to the region where the
iissura calloso-marginalis takes a horizontal direction : the lower
part of this convolution was transformed into a whitish mass. The
structure of the corpus callosum was recognizable at a plane pass-
ing through the gyrus centralis anterior. The fornix anterior
was not recognizable, while the posterior was in good condition.
The ependyma dorsalis of the lateral ventricles was destroyed :
w^ithin the ventricular cavities, that were dilated, there was a gela-
tinous, white mass. There were cicatricial ridges in the head of
the caudate nucleus. In the left hemisphere there was, besides, a
part of the convolution of the prcecuneus that was also of yellow-
SOFTENING, GENU CORPORIS CALLOSI.— A. Giannelli. 55
brownish color. The convolution of the corpus callosum was
completely destroyed ; the head of the caudate nucleus was normal
on this side; the third ventricle was spacious. The commissura
mollis was absent. The anterior and posterior commissures were
present. The fourth ventricle was dilated and filled with a tur-
bid fluid. The pons Varolii, medulla oblongata and cerebellum
were normal.
P, Marie and G. Guillain's case.— A man, 62 years of age;
apoplectiform attack ; loss of consciousness ; right hemiplegia with
spasmodic tendency. Right labial commissure somewhat relaxed.
No hemi-anesthesia ; when pricked on the right side, he becomes
agitated, attempts some movements, but never carries the hand of
the healthy side to the point pricked. If pricked on the healthy
side, he immediately carries his hand to the point pricked. Knee
reflexes normal on both sides, the cutaneous plantar reflexes
caused extension of the toes in the right and flexion in the left
foot. Cremasteric reflex abolished on both sides; pharyngeal
reflex normal. No aphasia, but dysartria. Study of articular
sensibility and stereognostic perception not possible. The patient
stared toward the left side without his head being turned in that
direction. Approaching the fingers .to the patient's eyes, in the
right visual field, did not cause "clignements des paupieres,"
while this sign existed on the left side. Impossible to make the
patient put out his tongue ; rectal and vesicular sphincters normal.
No albumen or sugar in the urine. Heart normal.
February 2, 1902. — The patient gave his name when asked to
do so ; could not put out his tongue ; when his cap was dis-
lodged he put it on properly. Muscular contractions in the right
thigh especially of the extensor cruris quadriceps. It seem.ed
that dolorific perceptions that caused the patient agitation were
more distinct at the roots than at the ends of the limbs.
April 2, 1902. — Muscular jerks, choreiform movements of the
arm, forearm and hand. Spasmodic movements also in the left
lower limb, displacing it now and then.
May 2, 1902.— Choreiform movements marked. No paralysis
on the left side. No choreiform movements in the right upper
limb that was paralyzed. Pulse 136, respiration 45.
Death. — June 2, 1902.
Autopsy .^White softening of recent date, the size of a dime,
of the genu corporis callosi; the focus extended about i J^ centi-
metres into the substance of the left hemisphere but not into
the right one. A section passing immediately above the genu
showed, on the left: destruction of the head of the caudate
nucleus, the focus being of somewhat older date than was the
56 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
white softening. In the lower part of the left hemisphere, near
the occipital end, there was a focus of softening the size of a
hazel nut. The cuneus in the right hemisphere was almost entirely
destroyed by softening of some months' duration; the lesion
extended into the lohulus lingualis. There were also small
focuses of porous degeneration in the posterior end of the len-
ticular nucleus. Nothing abnormal revealed by section through
the pons Varolii and medulla oblongata.
Kaufmann's case is of great importance from an anatomo-
pathological point of view, as it was the first and only case of
softening caused by embolism of the entire corpus callosum ; the
seat of the aneurism, at the origin of the arteria communicans
anterior, making the passage of the emboli equally possible into
the right or the left arteria corporis callosi. Such a case cannot
be utilized clinically, however, because it was impossible to study
the patient during life, he having been brought to the clinic in
a moribund condition and having died the first night after admis-
sion there.
P. Marie and Guillain's and my own case are the only ones
published, up to date, of softening of the genu corporis callosum,
that can be utilized for establishing the symptomatology cor-
responding to the lesion in that region.
The disorders accompanying lesions of the corpus callosum
have been studied especially in relation to neoplasms in that
body ; the diagnostic signs in that relation are pointed out as
follows: I, absence or slightly marked general phenomena, such
as headache, epileptiform attacks, choked disk (Bristow,
Ramson) ; 2, association of hemiplegic phenomena slightly
marked on one side and paralysis on the other ; 3, gradual onset
of the hemiplegia greatly resembling in its manifestation that
observed in hemorrhages and softening of a cerebral hemisphere ;
4, stupor due mostly to somnolence, bad nutrition and aphasia
(Bristow) ; 5, slow and gradual psychic changes, which in acute
cases appear as accentuated stupor, while those of slower course
are characterized by hallucinations, irritability and maniacal at-
tacks (Ramson) ; 6, progressive course of the symptoms, the
cranial nerves remaining free from pathologic manifestations
(Bristow); 7, contractions without pareses; bilateral spasms or
else more marked on one side (Ramson) ; 8, slight impairment of
the tendon reflexes (Ramson).
Mingazzini claims that the above mentioned criteria are not
constant and are rather accidental (mehr zufaelligen Charakter
tragen). In his cases, the double hemiparesis with unimpaired
cranial nerves and intact insensibility made the supposition of a
SOFTENING, GENU CORPORIS CALLOSI.— A. Giannelli. 57
neoplasm at the base of the skull highly improbable, and pointed
rather toward the corpus callosum as the seat of the neoplasm;
in other words, there was a coincidence here of two signs, positive
on the one hand and negative on the other. Buret looks on such
conditions as being pathognomonic of tumors of the corpus cal-
losum; Mingazzini looks on these signs as being much more
reliable than are those indicated by Bruns, according to whom the
absence of symptoms, pointing toward another localization, consti-
tutes the only criterion of a tumor of the corpus callosum.
Schupfer has tried to find out whether it was possible to deter-
mine the exact seat of a tumor of the corpus callosum, i. e,, in
the genu, corpus or splenium. According to him, a tumor may
be localized in the genu : when psychic disturbances set in a long
time before the motor troubles, when an isolated branch of the
inferior facial nerve, on one or both sides, is early involved (com-
pression of the fibres derived from the operculum), when the
head is turned to the paralyzed side and in general when there is
contracture of the muscles of the neck (compression of the fibres
derived from the motor centres of the frontal lobe), when the
pareses of the upper extremities are more marked than those of
the lower and when the impairment of gait resembles cerebellar
ataxia. When a tumor involves the middle part of the corpus
callosum paralysis takes place synchronously in the upper and
lower extremities, the trouble becoming progressively complete.
When a tumor involves the splenium, paralysis begins in the
lower extremities ; the regions supplied by the facial nerve remain
intact and the symptoms resemble those characterizing tumors of
the cerebellum.
In Mingazzini's case (tumor of the genu corporis callosi) only
two of the signs indicated by Schupfer existed ; Mingazzini con-
cludes that the symptomatologic criteria of tumors of the corpus
callosum, and especially of those involving the genu, are not firmly
based ; so much so that to-day no clinician would base his diag-
nosis on the criteria mentioned above. He adds that an analysis
of the published cases of tumors of the corpus callosum shows
that the hemiplegias or tetraplegia were due exclusively to com-
pression or destruction of the motor fibres passing through the
internal capsule or lenticular nucleus; and when there is dis-
sociation of the paralyses (mono-pareses or pareses of the upper
or lower extremities only) the trouble is caused by penetration
of the tumor into the centrum ovale, compressing either the cor-
tical brachial or cortical crural fibres only, of one or of both sides.
These conclusions are not in accord with the results of Schaefer
and Mott's experiments, according to which stimulation of the
58 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
entire surface of the corpus callosum causes movements on both
sides of the body ; and after section of the corpus callosum, stimu-
lation of one surface caused movements to take place only on the
contralateral side to that stimulated; from these facts it was
concluded that the movements were due to indirect stimulation
of the motor centres transmitted by the fibres of the corpus cal-
losum.
Lo Monaco, on the contrary, obtained no motor reaction from
stimulation of the corpus callosum; he further demonstrated
that in animals complete longitudinal section of the corpus cal-
losum could be made without there resulting any disturbance.
Operating on monkeys, Albutt also found that this operation was
harmless and negative as regards motor and sensory fimction.
Koranyi arrives at the same conclusions from his operations on
dogs.
Before confronting the above indicated criteria with the symp-
toms of Marie-Guillain's and my own case it is well to call to
mind that in cases of softening of the corpus callosum the symp-
tomatology is established suddenly, not gradually, as is the case
in encephalic tumors. Besides, it is well to note that the hemiopia
in Marie-Guillain's case * was due to an old lesion of the cuneus
and lobulus lingualis in the right hemisphere ; this trouble
should not be included, therefore, in the symptomatology of
lesions of the corpus callosum. As in my case, for instance, the
risus spasticus, from which the patient had suffered before the
onset of the apoplectiform attack, was due to an old lesion of the
cms anterior capsules internoe; and the anisocoria and pupillary
rigidity existed before the occurrence of the final apoplectiform
attack.
In Marie-Guillain's case hemiplegia with spastic tendencies
developed and its extension resembles that observed in cerebral
hemorrhages and softening (Bristow criterian) : there were
partial muscular contractions in the right thigh and choreiform
movements in the left extremities ; all this may be brought under
Ramson's sign indicated by the number 7.
In my case there v/as left hemiplegia with marked right hemi-
paresis with a tendency to bilateral spasmodic movements ; this
fact could be brought under the heading of the criterion given
by Bristow, which is also accepted by Ramson: association of
not well defined hemiplegic symptoms on one side with paralysis
of the other.
(*) The authors found right hemiopia and a lesion of the right hemi-
sphere. There must certainly be a typographic error : if the hemiopia
was on the right side, the lesion of the cuneus should have been on the
left side, and vice versa.
SOFTENING, GENU CORPORIS CALLOSI.— A. Giannelli. 59
In my case, as well as in Marie-Guillain's, the cranial nerves
were intact, — a condition corresponding to that indicated by
Bristow for the localization of tumors of the corpus callosum.
In Marie-Guillain's case the knee reflexes were normal on both
sides, while in mine they were exaggerated; and Ramson
observed slight impairment of the reflexes in cases of tumors of
the corpus callosum; in Marie-Guillain's case Babinski's reflex
was obtained on the right side, while in mine no reaction was
obtained by plantar stimulation. Marie-Guillain found absence
of the cremasteric reflexes on both sides, normal pharyngeal
reflex and deviation of the eyes toward the left side ; in my cases
the abdominal and tendon Achillis reflexes were wanting and
the patient's head was turned to the left, without her eyes being
turned in that direction. In both cases the patients could not
protrude the tongue. Marie-Guillain's case presented dysartria,
while my case did not speak (aphasia?)
The truly pathognomonic sign of the seat of a tumor of the
genu corporis callosi, indicated by Schupfer, was found in my
case only : deviation of the head toward the hemiplegic side and
contractures of the muscles of the neck and nape.
In cases of tumors of the corpus callosum with hemiplegia
Steinert lays stress on the diagnostic significance of the more pro-
nounced paralysis of the lower extremities — this condition being
reversed in usual types of hemiplegia. Marie and Guillain do
not make any remarks on this subject, stating simply that the
patient could not move the right side of his body. My patient,
on the contrary, had left hemiplegia and right hemiparesis, the
latter becoming more marked in the lower than in the upper
extremity.
It should be borne in mind that in both cases anesthesia of the
paralyzed parts was absent: when pricked, the patients became
excited and screamed but did not attempt to push away the
oflfending agent and, although they readily moved their hands,
did not carry them to the pricked region ; yet, when pricked on
the non-paralyzed side (Marie-Guillain's case), the patient im-
mediately put his hand on the pricked region, as normal people
generally do. This fact points toward an impaired psychic syn-
thesis of the patient.
In my case, risus spasticus ceased immediately after the apoplec-
tiform attack in the corpus callosum; the patient's face was
expressionless, the facial lines effaced, and she stared vacantly;
she did not answer any questions addressed to her, did not eat
spontaneously, although she swallowed liquids put into her
mouth; in a word, she was in a stuporous condition. >
6o JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
Bristow has pointed out that in tumors of the corpus callosum
the stuporous condition of the patient is due to somnolence, im-
paired nutrition and loss of speech. According to Ramson, the
stupor is always more marked in acute cases, while in those of
gradual development the psychic disturbances are expressed by
hallucinations, irritability and maniacal attacks.
In one of my studies, made in 1897, ^ considered the effects
of encephalic tumors on mental function; I analyzed 588 cases,
323 of which presented mental disturbances. I pointed out that
tumors of the corpus callosum were always accompanied by
psychic disturbances. My statement was confirmed by Schuster,
Knapp and Maggiotto. According to the data I then adduced,
psychic disturbances due to encephalic tumors occurred in the •
following percentages according to the region involved : Corpus
callosum, 100%; frontal lobe, 79.3%; temporal lobe, 66.6%;
hypophysis and its surrounding tissues, 65.3% ; occipital lobe,
60% ; in multiple tumors, 59.69^ ; pineal gland, 53.8% ; parietal
lobe, 52.1%; basal gangha, 50%; cerebellum, 35.5%; motor
convolutions, 28.8% ; cerebral axis, 25.0%.
According to Schuster, when tumors are located in front of
the corpus callosum, the patient suffers from psychic debility;
and if the tumor is situated posteriorly, delusional ideas develop.
The symptoms found in the two cases of partial softening of
the corpus callosum seem to strengthen Schuster's opinion. Marie
and Guillain make no mention of stupor in their case, but remark
that mental obnubilation of their patient prevented their examina-
tion of articular sensibility, etc. My case presented a distinct
stuporous condition. These two cases of softening of the pars
anterior corporis callosi are certainly of greater importance than
are those of tumors in the same region. I do not wish, however,
to present a differential diagnosis between a destructive lesion
limited to the pars anterior corporis callois and the posterior part
of this body, because I do not know of any cases of destructive
lesions (hemorrhage, softening) involving only the posterior part
of the corpus callosum.*
(*) Pelnar and Skalika {Revue Neurologique, p. 44p 1902) found, like in
the two cases related above^ two other cases in which the lower part of
the splenium corporis callosi was of a brown color; this discoloration
could be followed to the supra-ependymal layer of the inner part of the
cornu posterior. There were found focal destructions in other parts of
the brain. These cases cannot be utilized for the study of the symp-
tomatology of lesions of the splenium. See also Marie, Revue neurolo-
gique, 1902,
There were also published two cases of hemorrhage of the corpus cal-
losum: Erb {Virchow's Arch., Bd. 96) and Hougberg (Neurol. Centralb.,
1894, S. 227). Both cases are quite similar as to the localization of the
lesions and the course of the disease; they seem to indicate that integrity
SOFTENING, GENU CORPORIS CALLOSI.— A. Giannelli. 6i
The pathology of the corpus callosum is as yet insufficiently
known for the purpose of establishing a positive diagnosis as
regards the exact seat of a lesion in that body (in its totality or
only in a given part of it). Yet it seems to rne that the analysis
of the symptoms observed in cases of tumors of this body and the
clinical histories of the two cases of partial softening of the corpus
callosum related above warrant the following conclusions :
1. Double hemiparesis either of equal intensity or more marked
on one side, with spasmodic tendencies, or hemiparesis with
symptoms of motor irritability on the other side (partial muscular
contractions, choreiform movements, etc.), with unimpaired
function of the cranial nerves point with sufficient exactness
toward a lesion in the corpus callosum.
2. Absence of anesthesia of the paretic or paralyzed parts and
defect of psychic synthesis of artificially provoked dolorific sensa-
tions in the paralyzed parts also point to a lesion in the corpus
callosum, and may indicate that there is a lesion of the anterior
part of the corpus callosum.
Rome, 1907.
REFERENCES.
1. Albutt. — Trattato delle malattie del sistema nervoso. Italian
translation. Torino, Unione tipografica, 1905.
2. Bechterew. — Unaufhaltsames Lachen und Weinen bei Hirn-
affektionen, Arch. f. Psych., 1894.
3. Brissaud. — Legons sur les maladies du systeme nerveux,
2-me serie, 1899. Le rire et le pleurer spasmodique. Revue
neurologique, 1900.
4. Bruns. — Die Geschwuelste des Nervensystems, Berlin, 1897.
5. Bristow. — Brain, July and October, 1884.
6. Charcot. — Cas de rire spasmodique. Legons cliniques de la
Sapetriere, 1887-88.
7. Crocq, J. — -Cas de sclerose en plaques avec fou rire, Societe
Beige de neurologic, Annuaire, 1900.
8. Duret. — Les tumeurs de I'encephale. Alcan, Paris, 1905.
9. Fere. — Le fou rire prodromique. Revue neurologique,
1887-88.
of this part of the brain is not indispensable because motility, coordina-
tion, sensibility and speech were normal in both cases. See also Infeld's
case: Ein Fall von Balken Blutung, nebst einen Beitrag zur Zufassung
hysterischer Erscheinungen {Wien. Klin. Wochenschrift, 1902).
Marchiafava and Bignami's case should also be considered in a study
of lesions of the corpus callosum (Rivista di patologia nervosa e mentale,
vol. VIII, p. 544), in cases of alcoholism.
62 JOUKNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
10. Franceschi. — Sul meccanismo patogenetico del rise e del
pianto spastico e sulla funzione motoria del nucleo lenticolare,
Rivista di patalogia nervosa e mentale, Vol X., 1905.
11. Giannelli, A. — Contributo alio studio del risus spasmodicus,
PoliclinicOj 1907.
Gli effetti diretti ed indiretti dei neoplasmi encefalici sulle
funzioni mentali, Policlinic o, 1897.
12. Giannuli, F. — Riso e pianto spastico, Annali dell 'Istituto
Psichiatrico della R. Universitd di Roma, Vol. IV., 1905.
13. Kaufmann. — Zweiter Fall. Totale Erweichung des Balkens
durch Embolie, etc., Arch f. Psych., Bd. XIX., S. 237, 1888.
14. Knapp. — The mental symptoms of cerebral tumors. Brain,
CXIIL, 1906.
15. Koranyi. — PHueger's Archiv, Bd. XLVII.
16. Lo Monaco. — Sulla fisiologia del corpo calloso, Rivista di
patologia nervosa e mentale, VII., p. 145.
17. Maggiotto. — Contributo alio studio dei tumori cerebrali,
La Clinica medica Italiana, No. 5, P. 339, 1906.
18. — Marie, P. and G. Guillain. — Ramollissement du genou du
corps calleux, Revue neurologique, p. 281, 1902.
19. Mingazzini. — Sulla sintomatologia delle lesioni del nucleo
lenticolare, Rivista sperimentale di freniatria, Vol. XXVIII.
Klinischer Beitrag zur Kenntniss der Hirntumoren, Monatschr.
f. Psych, und Neurol., Bd. XIX.
20. Monakow. — Gehirnpathologie, Wien, 1905.
21. Ramson. — Brain, p. 531, 1895.
22. Rummo. — Crises de pleurs, de rire et de baillements chez
les hemiplegiques, Revue Neurologique, 1898.
23. Schaefer and Mott. — Brain, 1890.
24. Schupfer. — Sui tumori del corpo calloso e del corno di
Ammone ; studio clinico ed anatomopatologico, Rivista sperimen-
tale di freniatria, XXV., 1899. ,
PROGRESSIVE CHRONIC CHOREA. A CLINI-
CAL AND ANATOMO-PATHOLOGICAL
STUDY.
By Dr. Rodolfo Bonfigli, Senior Physician, Hospital for the
Insane, Rome, Italy.
(From the anatomo -pathological laboratory. Director, Prof.
Mingazzini.)
Huntingdon was the first to describe the clinical features of
progressive chronic chorea which is also termed degenerative or
hereditary chorea of Huntingdon. He was the first to group to-
gether the salient features of the disease as they were described
by physicians of his day and as he had observed them in a large
number of cases that had been almost endemic on Long Island ( i ) .
His extensive experience with this disease together with his inti-
mate knowledge of it as he had observed it among the members
of his own family enabled him to present a complete description
of the etiology and symptomatology of the affection. The de-
scription presented by him in 1872 attracted universal attention
of the medical profession.
Degenerative chorea is essentially a chronic disease of slow and
progressive course, hereditary in most cases, setting in almost ex-
clusively during adult life. Subjects of the lower walks of life
seem to be more prone to this disease than are the well to do.
The disease sets in with well marked choreic movements and with
psychic disturbances ranging between simple intellectual enfeeble-
ment and complete dementia.
I make this summary mention of the salient features of the
disease simply in order to compare them with those observed in
the case that is the object of this paper. The main physical and
psychic symptoms of this case corresponded well to the classic
features of Huntingdon's chorea ; but the history of the case was
rather deficient and it was difficult for me to find any hereditary
predisposition, which, according to some authors, is one of the
most essential traits of the disease.
(54 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
The patient, A. E., of Terracina, 42 years of age, driver, was
admitted to the Hospital for the Insane, at Rome, December, 1900.
According to the patient, neither of his parents had suffered from
any diseases of importance or had had chorea. His father had
been addicted to alcohoHc drinks and died of pulmonary hemor-
rhage at the age of 50 years. His mother died during childbirth.
There were no other children in the family. The patient had al-
ways enjoyed good health, was addicted to the use of large quan-
tities of wine and to sexual excesses. His disposition was quiet
and he managed to attend to his work properly. Married when
21 years of age, and seven children were born during this union.
The first born died of pulmonary tuberculosis when 21 years of
age ; the second child died of meningitis when 14 months old ; the
third child died of "convulsions" when 32 months old ; the fourth
and fifth children (twins) died of diphtheria; the sixth child died
of "convulsions" at the age of 17 months ; the seventh child died
during infancy of a disease of childhood.
The patient became afflicted with choreic movements 18 months
before his admission to the asylum ; these movements were so
slight in the beginning that he himself was not aware of them,
but his coworkers had directed his attention to them. These
movements became more and more accentuated as time passed on ;
with the gradual accentuation of the choreic movements his mind
also began to show signs of impairment. He became more and
more irritable and suffered from increasing sexual excitation.
These were the two distinctive traits of his disturbance in connec-
tion with the choreic movements. He had sexual connections
with his wife from three to five times during the 24 hours and
had connections with a number of women besides. His general
irritability became so marked that at the slightest provocation
he committed acts of marked violence ; this was especially the case
after he had indulged in alcoholic excesses. His outbursts of
violence became so marked that it became necessary to commit
him to the asylum.
Condition on admission. — Bony frame well developed, general
nutrition fair, thoracic and abdominal organs in fair condition ;
pupillary reaction to light and accommodation good; tendon re-
flexes of the upper extremities abolished; patellar reflexes con-
siderably impaired; systematic examination of motility impossible
because of the marked choreic movements. Head, eyes and neck
continually disturbed by choreiform rapid but superficial move-
ments; the shoulders move up and down, as if shrugging, the
fingers are continually in motion, the hands assume now a prone,,
now a supine position. The lower limbs are less involved in these
PROGRESSIVE CHRONIC CHOREA.— Dp.. Bonfigli. 65
movements. The right side of the body is more affected by the
movements than is the left one. Muscular force impaired.
Psychically the patient did not present any other features than
mental debility, especially as regards the affective sphere and
that of morality. He readily adapted himself to his surroundings
in the asylum, showing a marked liking for playing cards with
the other inmates; he always refused to perform useful work
allotted to him in the ward. He constantly complained of every-
Ihing and everybody and always sided with those of the inmates
who were most depraved morally. His physical and psychic dis-
turbances became progressively accentuated: in the early part of
1905 the physical disturbances became so marked, especially the
impairment of gait, that he could walk only with the utmost diffi-
culty. Toward the end of the year he could no longer hold him-
self on his feet and remained confined to his bed. The choreic
movements then became most marked and generalized, so that his
limbs were continually in the act of incoordinate movement, the
limbs and various parts of his body now flexing, now extending
without any aim, and his speech finally becoming unintelligible.
The muscles supplied by the facial and lingual nerves, and the
muscles of the neck were also animated by continual incoordinate
movements, so that deglutition became difficult and even danger-
ous ; the hands presented athetoid movements. When the patient
was excited the violence of these incoordinate movements was
at its maximum, but during sleep the movements ceased. The
irritability and impulsive acts which were marked features from
the very beginning of the disease became progressively more
marked with the course of the disease : at the slightest provocation
the patient screamed and fought, dealing blows with his fists,
scratching with his finger nails or biting those near him. April,
1906, the patient died of marasmus, at the age of 48 years. The
choreic movement ceased about eight hours before death took
place.
Autopsy. — The autopsy was performed 24 hours after death.
Cranial bones considerably thickened especially at the convex-
ity; frontal bones measured 12 millimetres in thickness. Dura
mater considerably adherent to the skull cap ; pia mater thick-
ened, especially along the inter-hemispheric fissure and in the parts
covering the median surface of the hemispheres ; anteriorly there
was marked adhesion between the two hemispheres ; in the rest of
the hemispheres the pia mater tore off easily. The convolutions
looked wasted and the fissures gaping. The cortical substance
was of a red-grayish color. A cut was made to expose the lateral
ventricles ; this cut showed a pale, edematous surface, pitting
^ JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
under pressure with the finger. The fornix and the choroid
plexus were adherent to the dorsal surface of the optic thalamus
in both hemispheres. Both optic thalami seemed to be wasted and
softer to touch than normal. The lateral ventricles were dilated,
especially in the posterior horns, and filled with a clear serous
effusion. Nothing of note in the rest of the cerebral axis.
The lungs were emphysematous and edematous, without show-
ing any traces of tubercles. Heart small, of brown color, with
aortic insufficiency; small areas of arterio-sclerosis in the aortic
arch. Liver of normal size and its cut surface dark. Spleen small,
brown and of normal consistency. Right kidney very small, the
cortical part not readily distinguished from the medullary one;
renal capsule easily torn off; this kidney contained in its upper
extremity a calcified cyst, about ^ centimetre in diameter, ex-
tending one centimetre into the kidney substance and involving
both the cottical and medullary substances. Left kidney normal.
Pieces of the brain were taken for microscopic examination
from the following parts : superior frontal convolution, anterior
central and superior temporal convolutions; from the lobules of
the calcarine fissure and the gyrus rectus. Some of these pieces
were hardened in MuUer's fluid, some in alcohol (96 degrees) and
some in an aqueous solution of a 10% solution of formol. Some
of the pieces hardened in alcohol were, previous to staining them,
imbedded in celloidin and some were not. In either case they
were stained with methylene blue and Nissl's stain, with thionin,
with toluidin and with cresyl-violet. The pieces hardened in for-
mol were stained with Bielschowsky's method for studying the
neurofibrils, and with Weigert's or Benda's method for the study
of the neuroglia. For the study of the nervous fibres I used the
Kulschitzky-Wolters method on the pieces hardened in Muller's
fluid. Some of the pieces, taken from the convolutions men-
tioned, were kept in pyridin and then treated with Donaggio's
fourth method (3) for the study of the endocellular network and
the long fibrils. The spinal cord and the peripheral nerves were
hardened in alcohol (96%) and in Muller's fluid; these pieces
were stained either with NissFs methylene-blue and cresol-violet
or with van Gieson's method. Pieces of muscles were hardened
in alcohol, imbedded in paraffin and stained with hematoxylin-
eosin and with ferric-hematoxylin and picric acid-fuchsin, — ac-
cording to van Gieson-Weigert.
Microscopic Examination. — Sections of specimens treated
with Nissl's method, thionin, etc., under low power (obj. 4, ocular
4, Koriska) : diffuse cellular alterations, especially in the motor
convolutions, in which there is a marked decrease of the cellular
PROGRESSIVE CHRONIC CHOREA.— Dr. Bonfigli. 67
elements as compared with an increase in number of the nuclei of
neurolgia cells. The latter are seen in groups here and there
taking up large spaces deprived of nervous cells. The nervous
cells are highly colored and most of them are surrounded by nu-
merous nuclei of neurolgia cells. The layers which should contain
a large number of the Betz giant cells present only few of these
elements and they appear profoundly altered. The blood vessels
are numerous.
Examination under higher power (objective 1/12, homogene-
ous immersion, ocular 4) of a section of the cortex of the motor
convolution showed grave alterations of the nervous cells (fig.
i). The small pyramidal cells presented diffuse central and
peripheral chromolysis: the cellular protoplasm was reduced to
fine granulations which were highly colored; the nucleus was
granular, more highly colored than the protoplasm, and contained
a well defined nucleolus but situated eccentrically. Some of these
cells were in a state of advanced disintegration and presented
almost complete destruction and disappearance of the cellular
body ; in some of these cells the nucleus was filled with granular
matter and the nucleolus was distinguished with difficulty. Nu-
merous neuroglia cells were seen around such cells ; other nuclei
were seen in groups surrounding pigment granules, and in this
mass of nuclei could be distinguished here and there nuclei which
had escaped from nervous cells still containing their nucleoli. The
cellular prolongations could be followed at a long distance and
were serpiginous in their course. The medium pyramidal cells
seemed less altered, and in many of them Nissl's bodies could be
readily distinguished; their nuclei were well defined, discolored,
while their nucleoli were highly colored. The cellular prolonga-
tions, especially the apical prolongations, were long and tortuous.
Similar alterations were seen in the large pyramidal cells, al-
though their prolongations were less extensive and appeared
broken off; their nuclei often did not present any well defined
contour and were recognizable only through the presence of the
nucleoli; the latter were circumscribed by a transparent disk or
halo, in which could be distinguished 3 or 4 large highly colored
granules. In Betz's giant cells the chromolysis was more central
than peripheral ; in some of them Nissl's cells could still be seen
at the periphery, where they were highly colored ; these cells are
rich in pigment and are stained yellow-greenish by Nissl's method.
The nucleus was generally well defined and highly colored, but
in some cells its contours were not well defined : the cellular pro-
longations were straight and had a long course. The neuroglia
nuclei did not present any marked alterations as regards their
68 JOURNAL OF MENTAL PATHOLOGY. Vol. VIll, No. z
form and volume. They were, as usual, either small and highly
colored, or larger than usual and slightly stained; or, when still
larger, they were colorless and filled with granulations. These
cells were more numerous than usual and grouped in large num-
ber in some parts, as has been remarked above. This neuroglia
proliferation is much more evident in sections of the cerebral
cortex treated with Weigert and Benda's methods: the very fine
fibres form a cobweb network, run a long, zig-zag course and
appear broken here and there. The blood vessels were numerous
and presented a marked increase of the endothelial cells; the
lumen of the vessels was narrowed and their walls thickened;
pigment granulations could be seen in these walls as well as out-
side of them. A large number of the vessels were filled with blood
clots, some of which contained polynuclear leucocytes. I have
not found any plasma cells in my sections.
In the other zones of the cerebral cortex I found alterations
similar to those described in the central convolutions ; the scarcity
of the nervous elements as compared with the neuroglia prolifera-
tion was not quite as marked, however; the alterations mostly
bore marks of acute degeneration: the cells were often swollen,
contained an oval or round nucleus, of very large size, only
slightly stained, and containing one or more nucleoli; the pro-
longations ran a more or less long course and were serpiginous
in shape (fig. 2).
There were not many alterations in the cerebellum : only rarely
some Perkinje cells presented initial stages of chromolysis, the
greater number of them being in good condition and showing
distinctly Nissl's bodies ; the nuclei were almost colorless and the
nucleoli well defined ; the cellular prolongations were very short.
Nothing abnormal in the granular layer (fig. 3). The blood
vessels did not present any marked alterations, but most of them
were filled with red blood corpuscles among which could some-
times be seen polynuclear leucocytes. In the spinal cord neither
the ganglion cells nor the neuroglia cells presented any altera-
tions. The blood vessels here presented the same characteristics
as those described in the cerebrum.
The sections prepared for the study of the neurofibrils were
examined under high power (objective 1/12, homogeneous im-
mersion, ocular 8, Koriska). The neurofibrils were very fine
in the prolongations of the pyramidal cells and could be seen dis-
tinctly; the fibrillary network, however, could not be seen dis-
tinctly ; at its best it could be seen as a finely granular mass with
some hint at a perinuclear network formation. The nucleus was
round or oval shaped, colorless, with a well defined nucleolus
JOURNAL OF MENTAL PATHOLOGY, Vol.. VHI, No. 2
FIG. I.
%-^ '
^^^.
li@^- • --^ ^-^^-^
via. 2.
/
*S ^
-'--. it?
>f. B'"ff^
^^i;
FIG 3
FIG. 4-
'4 %%^f '?;^
;\ e ®
iC^
PROGRESSIVE CHRONIC CHOREA.— Db. Bonfigli. 69
There were large masses of pigment, especially in the large pyra-
midal cells these agglomerations were seen between the neuro-
fibrils and in the body of the cells. The cellular prolongations ran
through a long course, and in some rare pyramidal cells could
still be distinguished the constituent fibrils of the pericellular
network; occasionally it was possible to see within the cell some
tracts of fibrils which ran from one prolongation to the other
(fig. 4). Outside of the cell the neurofibrils crossed one another
in all directions and looked broken on their serpiginous or zig-zag
course ; they were less numerous around the neuroglia nuclei, and
these nuclei were surrounded by large, colorless zones. The
breaking up of the fibrils was more marked in the white sub-
stance, where the fragments were club shaped or fusiform ; around
the blood vessels they were more numerous and longer, interlacing
in a thick network. In the cerebellum the neurofibrils were in
good condition : in the Purkinje cells the pericellular basket work
was in good condition and its constituent fibrils could be traced
along their entire course. Their connection with the fibrils of the
granular layer is always easily demonstrable (4). The fibrils of
the endocellular network could also be easily seen and followed
from the prolongations to the cellular mass which they traverse
following the curve of the nucleus and the walls. The nucleus
was colorless or almost so; the nucleolus was highly stained and
the granules presented no alterations. In the sections of the
cerebral cortex prepared for the study of the nervous fibres, the
projection and tangential fibres could be seen to be in good
condition, although they were very much decreased in number,
and the supra- and infra-radial were almost absent. The peri-
pheral nerves presented slight alterations: the perineurium was
slightly thickened, here and there the myelin sheaths were de-
stroyed, and the blood vessels filled with red blood corpuscles.
The muscles were normal.
Summary. — I found grave cellular alterations in all the zones
of the cerebral cortex ; the alterations were particularly marked in
the motor zone and consisted of central and peripheral chrom-
olysis and even total cellular destruction; partial destruction of
the neurofibrils; marked decrease and even total disappearance
of the deep associations fibres; neuroglia proliferation; vascular
proliferation; little, if any, changes in the cerebellum; slight
peripheral neuritis.
From the clinical history of this case it Is evident that the ques-
tion here is one of chronic progressive chorea or Huntingdon's
chorea. The hereditary nature of the disease, which the deficient
history of the case has made it impossible for me to bring to
70 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
light, although being one of the most important characteristics of
the affection, is not necessarily indispensable for the purpose of
establishing its clinical form. According to Debuck non-heredi-
tary but progressive chronic chorea is a form of the disease
medium between the acute and degenerative type of Huntingdon's
chorea (5) ; this differentiation is not accepted, however, by the
majority of authors, and familial choreic heredity of subjects
afflicted with degenerative chorea is considered as an etiologic
factor that does not always exist (6). Frank Kurt, for instance,
published a case of a woman afflicted with progressive chronic
chorea, who had no history of hereditary predisposition to the
disease (7). Alcoholic abuses and other physical debilities are
important factors in the etiology of progressive chronic chorea;
and it is possible that in my case these latter two agents were the
causes of the disease. As regards the insidious onset of the dis-
ease in my case, the choreic movements were so slight at the
commencement of the trouble that the patient was not conscious
of them and became aware of them only when his attention had
been directed to them by his friends ; such insidiousness of onset
has been pointed out in other cases (8). In my case the disease
set in when the patient was 41 years of age; this advanced age
is, according to Wollemberg (9), the most favorable period of life
for the onset of progressive chronic chorea. The social stratum
of society to which the patient belonged — the lower class — is also
considered as being favorable for the onset of the disease (10).
The choreic movements ceased during sleep ; this was the case
even when the disease was far advanced in its course ; this con-
dition is always found in cases of chorea (11, 12, 13). The
choreic movements ceased a few hours before death, as was
also the case in the instances published by Modena (14) and Vas-
chide and Vurpas (15) — cited by Modena; Vaschide and Vurpas
explain this fact by a secondary infection of the central nervous
system. In my case the disturbances of speech appeared rather
late in the course of the disease ; this disturbance is generally an
early manifestation and is due to the choreic movements of the
tongue and of the muscles of the larynx and the chest (16, 17).
Exaggeration of the patellar reflexes is generally a constant sign
in chronic chorea (18, 19), but in my case these reflexes were
rather impaired.
As regards the psychic symptoms in my case, the exact time of
their onset is not known ; from the history of the disease it ap-
pears, however, that these symptoms showed themselves after the
onset of the physical trouble; this succession of disturbances is
contrary to that pointed out by Westphal (20), who had ob-
PROGRESSIVE CHRONIC CHOREA.— Dr. Bonfigli. 71
served in one of his cases psychic disturbances five years prior
to the onset of the physical trouble. The high sexual excitement
in my case is worthy of note, as such disturbance is not mentioned
in any of the cases in question recorded in literature. This dis-
turbance was the predominant feature of his psychic trouble ; be-
sides, this disturbance is often observed in choreic subjects and
has justly been considered as being parallel to the impulsive
acts of subjects suffering from Basedow's disease (21). The
patient's mental status as death was approaching was above that
of mental dissolution so frequently observed at such times in
cases of degenerative chorea (22) ; this mental dissolution of other
cases has prompted some author to term the disease choreic de-
mentia and even to draw a comparison between this dementia
and dementia paralytica ; some authors even go so far as to claim
that, on account of the dementia, it is sometimes difficult to make
a differential diagnosis between these two dementias (23, 24) ;
according to these authors, choreic dementia is essentially heredi-
tary, familial and degenerative, while paralytic dementia is es-
sentially individual and of an infectious nature (25). The al-
terations of the cerebral cortex found in my case, like those found
in the majority of the cases of Huntingdon's chorea (26, 2y, 28,
29, 30), present a certain analogy with those found in the cortex
of cases of progressive paralysis : in both cases there is marked
glia proliferation to the detriment of the nervous cells, which pre-
sent marked alterations ; in both cases there is also vascular pro-
liferation and inflammatory processes in the same; but other ele-
ments were also found, and first among these are the plasma cells,
which, up to now, have not been found in chorea.
Is glia proliferation in chronic chorea primary or secondary to
Vascular inflammation? Today this question is being debated,
some considering the process as a result of a primary affection of
the nervous elements (31, 32) and the glia proliferation as a
secondary process — the glia cells being destined to occupy the
places of the nervous cells in a state of dissolution (33). Oppen-
heim and Hoppe, following in Golgi's path, speak of a dissem-
inated miliary encephalitis, cortical and subcortical (especially in
the motor zone), which could explain, in part, the pathogenesis
of Huntingdon's chorea; they claim that the minute hemorrhagic
focuses may produce an irritation, but cannot produce paralytic
phenomena, and the psychic symptoms may be explained by the
fact that these focuses are found not only in the motor zone but
also in other parts of the cerebrum (34).
In my case, as has been remarked above, the psychic disturb-
ances were slight while the somatic symptoms were very grave;
72 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2
and the microscopic examination showed, indeed, the most marked
cellular alterations in the motor zone. The vascular proliferation
was very marked and affected all the zones of the cerebral cortex
and especially the central convolutions ; the neuroglia was every-
where quite abundant, filling the spaces left vacant by the de-
generated or destroyed nervous cells; this increase of neuroglia,
consecutive, perhaps, to the vascular inflammation, could suffice
in itself to explain the secondary degeneration and destruction
cf the nervous elements. In my opinion, we are not justified,
therefore, in accepting without reserve Modena's claim (35) that
chronic degenerative chorea is due to * 'congenital deficiency of
some of the nervous elements" ; this deficiency may, in all proba-
bility be due to the action of microorganisms and toxin, which,
like in Sydenham's chorea, are carried into the circulation at a
certain period of life. In that case the disease would be hereditary
in the same sense that tuberculosis is hereditary : hereditary pre-
disposition to the disease at a given stage of life. Under these
conditions the inflammatory process of the vascular system may
be considered as primary and its special localization in the motor
convolutions may in all probability be explained on a simple me-
chanical ground, especially so when it is considered that the
median cerebral arteries, which supply the central convolutions,
lend themselves more than any other cerebral arteries to the trans-
portation of microorganisms and toxins into the regions which
they irrigate.
RoME^ January, 1907.
REFERENCES.
1. Ebstein, W. — Manuale di medicina pratica (Prof. Jolly, p.
776).
2. Nothnagel. — Specielle Pathologic u. Therapie: Chorea, etc.
(Prof. WoUemberg) s. 75.
3. Donaggio. — Azione della piridina sul tessuto nervoso, etc.,
Annali di nevrologia, anno 22, fasc. i ; 2.
4. Bielschowsky M. und Wolff, M. — Zur Histologic der Klein-
hirnrinde, Journal fiir Psychologic u. Neurologie, 4, p^ i.
5. Debuk, D. — Un cas de choree chronique progressive avec
autopsie, Journal de Nevrologie, N. 17, p. 321.
6. Ebstein. — Op. cit. p. 775.
7. Frank Kurt. — Zur Kenntnis der Chorea chronica progres-
siva (abstract), Jahresberichf f. Neurologie u. Psychiatrie, 1904,
6.. ^2^.
PROGRESSIVE CHRONIC CHOREA.— Dr. Bonfigli. 73
8. Nothnagel. — Op, cit., p. 86.
9. Nothnagel. — Op. cit., p. 85.
10. Nothnagel. — Op. cit., p. 75.
11. Nothnagel. — Op. cit., p. 86.
12. Liebers Max. — Beitrag zur Symptomatologie der Chorea
chronica progressiva, Centralhlatt f. N ervenheilkunde it. Psych-
iatric, 1905, s. ssy.
13. Frank Kurt. — Op. cit.
14. Modena. — Su di un caso di corea d'Huntingdon, Annuario
del manic omio provinciate di Ancona, 1905, anno 3.
15. Vaschide N. et Vurpas CI. — Essai sur la physiologic patho-
logique du mouvement, etc., Jahresb.ericht f. Neurologic u,
Psichiatrie.
16. Nothnagel. — Op cit., p. 88.
17. Liebers, Max. — Op. cit.
18. Nothnagel.— 0/>. cit., p. 88.
19. Liebers, Max. — Op. cit.
20. Westphal. — Ueber die Diagnose der Huntingdon'schen
Chorea in ihren Friihstadien, Centralhlatt f. N erven, u. Psych.,
1905, s. 674.
21. Ballet. — Traite de pathologic mentale, Paris, 1903, p. 866.
22. Nothnagel. — Op. cit., p. 75.
23. Marc. — Ueber familiares Auftreten der progressiven Par-
alyse, Alleg. Zeitschr. f. Psych., 61, 5.
24. Koebisch. — Fall von clioreatischer Bewegungsstorung, etc.,
Neurolog. Centr., s. 966.
25. Ballet. — Op. cit., p. 871.
26. Ebstein. — Op. cit., p. yy6.
27. Ballet. — Op. cit., p. 870.
28. Debuk.— 0/>. cit.
29. Liebers, Max. — Op. cit.
30. Modena. — Op. cit.
31. Modena. — Op. cit.
32. Debuk. — Op. cit.
33. Cerletti U. — Sulla neuronofagia e sopra alcuni rapporti
normali e pathologici fra elementi nervosi ed elementi non ner-
vosi, Annali deWistituto psichiatrico di Roma, 1902-03.
34. Oppenheim H. und Hoppe H. H. — Zur pathologischen
Anatomic der Chorea chronica progressiva hereditaria. Arch. f.
Psych., 1893.
35. Modena.-^O/*. cit.
RESUSCITATION OF ELECTROCUTED ANIMALS.
CHOICE OF THE ELECTRIC CURRENT AND
METHOD USED. APPLICATION TO HU-
MAN BEINGS. EXPERIMENTAL STUDY
OF THE RESPIRATION AND BLOOD
PRESSURE DURING ELECTRO-
CUTION AND RESUSCITATION.
A PRELIMINARY COMMUNICATION.*
By Louise G. Robinovitch, B es L., M.D. ( Paris )> Member,
New York Academy of Medicine, Member, American Medi-
cal Association, Foreign Associate Member, Medico-
Psychological Society, Paris.
In my paper entited ''Electrocution, An Experimental Study
with an Electric Current of Low Tension," etc., published in the
Journal of Mental Pathology, Vol. VII, No. 2, 1905, I pre-
sented two tracings of the respiration and blood pressure in a
rabbit subjected to a lethal electric current. Since this publication
I have made some further studies of the question of resuscitation
of electrocuted animals ; some details of these studies are em-
bodied in my thesis, presented at the Paris Faculty of Medicine,
July, 1906, entitled ''Sommeil Electrique (inhibition des mouve-
m.ents volontaires et de la sensibilite) par des courants electriques
de basse tension et a interruptions moderement frequestes. Epi-
lepsie electrique et electrocution," and are reproduced in this
paper.
The mode of resuscitation of electrocuted animals is simple and
its application to human beings may reclaim from death many
* Unless _ otherwise indicated, the current used is the Leduc current.
The experiments were made in the laboratories of physics and physiology,
in the School of Medicine, Nantes, France. The tracings were obtained
with Prof. Rouxeau's cardio-pneumograph. The technique for using the
current is described in my papers quoted here.
RESUSCITATION OF ELECTROCUTED ANIMALS.— Robinovitch. 75
who fall victims to electric shocks by touching ''live wires" carry-
ing ordinary lethal potentials — up to 2,000 volts.
In accidental electrocutions, with moderate lethal currents, the
victims are generally subjected to potentials of from 1,500 to
2,000 volts. If the contact is not good at the time of the accident,
the victim may escape death, but in a large number of cases death
is caused either immediately or a short time after the accident —
in spite of the usual restoratives administered by the physician.
I shall endeavor to elucidate in this paper the following points :
I. — The vital importance of understanding the mode of death
in electrocution.
2. That timely medical aid administered tO' the victim — when
he is still breathing or a short time after breathing has ceased —
may restore him to life.
3. — The importance of treating the sufferer immediately after
the accident and of not delaying the attempt at resuscitation until
the patient is transported to a hospital.
Electric industries are so universal today and are multiplying
so fast daily that accidental electrocutions are becoming more and
more prevalent. It is important for physicians, therefore, to know
how to meet these accidents.
First I shall consider the mode of death in electrocution, as it
has been demonstrated in my previous papers and in my thesis
mentioned above. In my previous papers experimental electrocu-
tion was practiced on rabbits, and the salient points bearing on the
respiration and blood pressure during electrocution are repro-
duced in part below.
Tracing No. i represents the cardio-pneumogram of a rabbit
suddenly subjected to a potential of 12 volts, during 20 seconds.
At A the current was closed and at B it was opened. The con-
dition of the cardiac beats and respiration during the action of
the current was precarious and the animal would have been
killed had the current been sent through its body a few seconds
longer. But the timely interruption of this lethal current at B
caused a spontaneous return of the respiration and cardiac beats.
In tracing No. 2 the same experiment is registered, but the cur-
rent is one of 14 volts ; the current is closed at A and opened 2i^
seconds later — at B. On opening the circuit, the animal re-
mained lifeless. At C rhythmic excitations were made with the
same potential, but life could not be restored.
The Mode of Death in Electrocution. — The mode of death
is well illustrated in tracing No. i, although the animal was not
electrocuted in that experiment. The tracing shows that the
respiration is compromised while the heart beats still continue to
76 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2.
be registered. Had the current been sent through the body of
the animal a few seconds longer, death would have taken place
and asphyxia with subsequent heart failure would have been the
prime cause of it. In a series of my experiments on electrocution,
the heart continued to beat after death and even after the chest
had been cut open and the heart laid bare in its pericardial sack.
In one case the heart continued to beat for over half an hour after
the autopsy. Of course, the beats were a vide, the left auricle
and ventricle being empty of blood.
In order to elucidate this question still further I reproduce
another tracing from my thesis, (p. 78). See tracings Nos. 3 and
4.*
Tracing No. 3 represents normal respiration and cardiac beats
of a rabbit. Tracing No. 4 represents the respiration and cardiac
beats of the same animal while subjected to a current of 12 volts.
In tracing No. 4 the illustration is striking as regards the relative
impairment of the respiration and cardiac beats under the influ-
ence of a current of 12 volts : there is inhibition of the respiration
while the cardiac beats continue in good condition. In the paper
in which this tracing was originally used by Professors Leduc and
Rouxeau, it was shown that respiratory inhibition could be kept
up for one minute without compromising the cardiac beats.
Tracings Nos. 3 and 4 illustrate the mode of death in electrocu-
tion as registered in my tracings, Nos. I and 2 ; when the current
is comparatively mild, as in tracing No. i, — a potential of 12 volts,
it is clearly seen that the first vital function compromised is the
respiration, — while the cardiac beats are still being registered.
When life seemed to be compromised, the current was inter-
rupted ; on opening the circuit, respiration was immediately
resumed, the cardiac beats improved and life was restored. In
tracing No. 2, on the contrary, respiratory inhibition was kept
up too long a time, 32 seconds, and besides, cardiac inhibition
was caused almost synchronously.** The breaking of the cir-
cuit did not restore the respiration and the animal remained
lifeless for 12 seconds thereafter. An attempt was then made to
cause artificial respiration by means of rhythmic excitations. In
many cases of electrocution and apparent death from lethal elec-
tric currents, rhythmic excitations, if applied in good time,
restored the animal to life, in a manner that will be shown here,
but in this instance the method was of no avail.
Rhythmic Excitations. — How to Produce Them. — In the
series of experiments on electrocution the rhythmic excitations
* Tracings lent me by Professors Leduc and- Rouxeau.
** The peculiar cardiogram in this tracing needs further study.
RESUSCITATION OF ELECTROCUTED ANIMALS.— Robinovitch. 'j'j
were produced by sending through the body of the electrocuted
animal, at rhythmic intervals of from 3 to 4 seconds, and during
one second, the current of the same patential which had caused
the death of the animal (14 volts, period i/io, and no inter-
ruptions per second). In the experiment recorded in tracing No.
2 these excitations proved useless. This does not indicate, how-
ever, that a potential of 14 volts is necessarily fatal when it is
allowed to pass through a rabbit's body during 32 seconds. In-
deed, the same dose of electricity was used and during a longer
period of time — ^42 seconds, on another rabbit, yet the animal
was brought back to life by rhythmic excitations with the lethal
potential. This experiment is registered in tracing No. 5 and is
a striking illustration of the mode of resuscitation of electrocuted
animals.
The animal was subjected in this experiment to a current of
14 volts (registering 2 milliamperes .75) during 42 seconds. The
relative impairment of the respiration and cardiac beats is strik-
ingly well recorded in this tracing No. 5. There is complete
respiratory inhibition with a precarious cardiac condition, and
apparent death takes place 42 seconds after the commencement of
the experiment. The circuit is then opened, at 0 , but the animal
remains lifeless. Eight seconds are allowed to elapse and still
the animal gives no sign of life. Rhythmic excitations are then
begun with the same potential that has caused apparent death.
The first seven respirations are artificial and caused by the rhyth-
mic excitations. Although the blood pressure is almost at zero,
the cardiac beats are again registered — irregularly, it is true, The
rhythmic excitations are then suspended. The respiratory move-
ments then take place spontaneously, become ampler and ampler,
and with the improvement of the respiration the blood pressure
gains in strength, rising higher and higher toward the normal.
Thus, it is seen in this experiment that the electrocuted animal
was brought back to life by rhythmic excitations with the same
potential that had caused death. The point of importance is the
fact that the excitations were instituted without great delay, —
8 seconds after the opening of the circuit; it was only after the
8th rhythmic excitation, at the end of 19 seconds of manipula-
tion (and 61 seconds after the beginning of the electrocution),
that the first spontaneous respiratory movement took place and
the blood pressure in the carotid artery commenced to rise.
That death was certain to conclude the experiment, if the
rhythmic excitations had not been applied, may be seen from the
fact that the gradual fall of the blood pressure in the carotid
artery, caused by the closure of the circuit, reached down to 4
78 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2.
centimeters of mercury; and the opening of the circuit did not
cause any rise of this pressure ; on the contrary, the pressure only
became lov/er and lower, as is registered in the tracing, beginning
to rise only after 8 artificial respirations had been produced.
It is important to note that the cardiac beats continued to be
registered by the manometer when the rhythmic excitations were
commenced. But the cardiac beats may continue to be registered
while the animal is dying of asphyxia, as is shown in my tracing
No. 2.* Hence, in the experiment of May i6, 1906, registered
in tracing No. 5, although the cardiac beats continued to be regis-
tered by the manometer, the animal would most certainly have
succumbed to the lethal current had not the rhythmic excitations
been applied on time and respiration brought into play.
The animal, the electrocution of which is registered in tracing
No. 5, was electrocuted twice in the same afternoon and both
times rescuscitated by rhythmic excications with the lethal current.
And regardless of this fact, and regardless of the fact that one.
of its carotid arteries had to be permanently ligated (complete
severing of the vessel while the canula was being introduced into
it) it made a good recovery.
Prompt Application of Rhythmic Excitations. — The es-
sential point in the resuscitation of electrocuted animals is the
promptness of application of the rhythmic excitations, or in other
words, — restoration of respiration without too long delay— after
the accident. If, indeed, the opening of the current does not
cause spontaneous respiration to appear and if one waits until
the manometer does not register the cardiac systole any more, too
much precious time has been lost and there is little chance of the'
rhythmic excitations causing respiration to reappear : life cannot,
therefore, then be restored.
I have experimented with animals under such conditions, one
of which is registered in tracing No. 2 ; others are not reproduced
here. In one of these cases the manometer ceased to register
the cardiac systole 60 seconds after the opening of the lethal cur-
rent, and rhythmic excitations instituted at that time were of no
avail, whereas in tracing No. 5, showing a timely application of
the rhythmic excitations, the animal was brought back to life.
To sum up the succession of inhibition of the vital functions
under the influence of lethal currents : — when the voltage is in-
creased to a lethal dose, the animal passes gradually from a period
of inhibition of voluntary movements and sensibility to one of
respiratory inhibition, which is soon followed by arrest of the
cardiac beats.
* The peculiar cardiogram in tracing No. 2 needs further study and
elucidation.
RESUSCITATION OF ELECTROCUTED ANIMALS.— Robinovitch. 79
Choice of Electric Current for Resuscitating Electro-
cuted Animals. — I do not propose to give any definite con-
clusions in this paper as to the absolute preference in the choice
of the electric current to be used for resuscitation of electrocuted
animals, reserving the full consideration of the subject for an-
other paper. I shall limit myself here tO' the presentation of
results obtained with two different electric currents^ laying par-
ticular stress on their respective effects on the respiratory centres
(and the respiratory muscles) and the blood pressure.
In my paper' on electrocution above quoted I pointed out that
the current of low tension used in these experiments does not
cause any marked muscular contractions. The subject of mus-
cular contractions under the influence of two different electric cur-
rents— the Leduc current and the common induction current — is
further studied in my thesis quoted above. It is graphically
demonstrated in my last work that electrocution with the Leduc
current is accompanied by only slight muscular tremors, the
muscles of the extremities being affected most by the current ; the
respiratory muscles, on the contrary, seem tO' be particularly free
from its effects, as may be judged from all the tracings presented
here showing the respiratory curves before respiratory inhibition
takes place. Things are quite different when an induction current
is used on the same animal (the apparatus used was an ordinary
sliding induction apparatus, and the electrodes were applied as
in the experiments with the Leduc current ; the coil used was No.
3 — ^of the finest wire of the series, and complete respiratory
inhibition was caused when the coil was moved up to 6.5 centi-
metres of the scale. The primary current was a continuous cur-
rent of 6 volts). Not only did the induction current cause
marked and generalized muscular contractions, but the respiratory
muscles seemed to be be the seat of overwhelming tetanic con-
vulsions even when the minimum effective dose of this current
was turned on. As soon as the current was sent through its
body, the animal was in a condition of visible suffering that was
painful to see ; with pupils dilated at the maximum, and convulsed
in all its muscles the animal struggled to free itself from the
torture, its eyes bulging from their sockets more and more as the
coil was being slowly moved up the scale ; its chest finally became
immobilized and death took place while consciousness of its
suffering was in full evidence.
During this experiment the trepidation of all the muscles in
general and of the respiratory muscles in particular was so intense
that the membranes of the recording drum vibrated with force
sufficient to cause a perceptible noise that could be heard at a
distance.
8o JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 3.
The trepidation of the respiratory muscles may be judged from
tracing ^NTo. 6, recording the commencement of this experiment.
The muscular trepidation began even before the coil had been
moved up to No. ii of the scale (see tracing No. 6).
The animal was then subjected abruptly to a stronger current
(coil moved up rapidly to 6.5. and 5.5. centimeters of the scale).
It was seen immediately that the blood pressure rose only slightly
at the moment of the closing of the current, only to fall immedi-
ately, and gradually reach to zero (see tracing No. 7). At that
moment, the manometer having ceased to register cardiac beats,
the current that had been coursing through the animal for 83
seconds was opened, but neither the respiratory movements nor
the cardiac beats (the beats registered by the manometer) reap-
peared (after the autopsy of such animals their hearts continue
to beat a vide for from 20 minutes to over one-half hour).
Tracing No. 7 shows distinctly the status of the blood pressure
in connection with the intense muscular tremors due to the
induction current: the blood pressure rises much less above the
normal than it does in electrocution with the current of low ten-
sion and gradually falls below the normal — ^'co reach zero.
I shall not stop to consider here in detail the interesting correla-
tion between the convulsive muscular movement and the low
blood pressure as compared with the respiratory movements and
blood pressure recorded in tracings Nos. i, 2 and 5. I only wish
to point out the fact that the induction current used here has a
detrimental effect on the respiratory centres and causes asphyxia
of the animal while it is still apparently conscious of the sufferings
caused it by this current. And while this asphyxia is taking
place, the normal strengdi of the cardiac beats and blood pressure
is reduced.
Considering the effects of the induction current on the respira-
tion and blood pressure, it seems to me highly improper to use
a high voltage of the induction current for the purpose of resusci-
tating electrocuted animals. The current of low tension used in
the experiments indicated seems to me to be of greatest value for
resuscitation purposes.
Application in Industrial Life. — In cases of accidental
electrocution or shocks with electric current of any low potential
up to 2,000 volts, more or less, it seems to me feasible to admin-
ister treatment to the victim as follows :
I. — Release the victim from the contact with the current.
2. — Use every means known that will stimulate his respiration
— until a physician arrives.
3- — The physician should arrive with the following outfit: an
interrupter, such as has been described in my articles mentioned
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Dr. RoBtNoviTCH.— the JOURNAL OF iw ' pATHOLOGY, Vol. VIII, No. 2,
From the Physiological Laboratory!^ gi "^ *^""''"'' ^''"'"'
Co u rant 14 V.5. 2 M.A. 7 5
0
Excitation Rythmicjue
RACING i 0. 5. Rabbit. Electrocution. Resuscitation by rhythmic excitations with the same cuncnit that caused the linal respiratory pause.
circuit; 2, commencement of rhythmic excitations; 3. '"^apPearance of spontaneous respiratory movements.
Commencing at O, the 3 signals indicate : i, opening of the
Dr. Robxnovitch.— the JOURNAL OF MENTAL PATHOLOGY, Vol. VIII, No. a
From the Physiological Laboratory, School of Medicine, Nantes.
Tracing No. 6. — From above downward: i, respiration (marked muscu-
lar trepidation) ; 2, cardiac beats; 3, position of the coil successively
placed at Nos. 11, 10.5 and 10 cts. of the scale.
(Continued in tracing No. 7.)
Dk. Robinovitch.— the JOURNAL OF MENTAL PATHOLOGY, Vol. VIII, No 2,
I'Vom the Physiological Laboratory, School of Medicine, Nantes.
T:.ACiNG No. 7.— llabbit. Electrocution with an induction current. Primary current 6 volts ; coil No. 3, placed successively at 6.5, 6 ^1"^ 5-5 cts. of the scale.
RESUSCITATION OF ELECTROCUTED ANIMALS.— Robinovitch. 8i
above; if the special interrupter described cannot be had, a simple
interrupter with a vibrating rod, constructed on the principle
of the electric bell mechanism will answer the purpose (I used
with success such a simple interrupter at the International
Congress of Psychology, held at Rome, Italy, in 1905) ; a plug
and wire such as are used for a drop light — to connect the reducer
of potential and interrupter with an electric source (direct cur-
rent) ; any ordinary battery of from 2 to 5 volts to be used as
motor power for putting the interrupter into action ; a reducer of
potential and a small mercury interrupter such as are used in
physiological laboratories; two electrodes — one for the forehead
and the other for the abdomen ; enough wires to make the neces-
sary connections (the technique is fully explained in my papers
already mentioned).
4. — The patient should be treated immediately and before he
is removed to a hospital.
5. — The patient should be carried into the nearest store or
house in which an electric source can be had; the instruments
should be put in a series, the electrodes applied to the patient
(negative to the forehead and positive to the abdomen) and
rhythmic excitations practiced by means of the small mercury
interrupter with as little delay as circumstances allow.
To the practiced hand the method is less complicated than
it appears to be. The method is particularly applicable in cities
where electric light is furnished by a direct current, as in certain
parts of New York. The question of using an alternating current
is more complicated; but interrupters with transformers can be
constructed for the use of either current. It remains for the
medical profession to familiarize itself first with this method of
resuscitating electrocuted subjects and then to present their wants
to the instrument constructors.
The results of my experiments with the induction current as it
relates to its effect on the respiratory centres do not warrant the
use of this current for the purpose of provoking artificial respira-
tion; but further studies of the subject are needed before revealing
any definite opinion as to its merits in this direction.
Some of the cuts reproduced here were embodied in my work
published in the French language, and this accounts for the
French inscription in one of the tracings.
It is with great pleasure that I once more present my thanks to
Professors Leduc, Rouxeau and Dr. H. le Meignen for their kind
advice and assistance in this work.
New York, February 28, 1907.
The Journal of Mental Pathology
Edited by Louise G. Robinovitch, B. es L., M.D.
Vol. VIII. 1907. No. 2
STATE PRESS, Publishers,
New York.
MSS. and Communications should be addressed to the Editor,
28 West 126th Street, New York.
Address bulky mail matter to P. O. Box 1023, New York.
This Journal is published in volumes of five issues each. Price of each
volume, $2.50. Single copies, 50 cents.
Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope.
WHAT paranoia IS NOT. A PLEA FOR AN
INTELLIGIBLE CLASSIFICATION OF
MENTAL DISEASES.
Our esteemed contemporary, the "New York Medical Journal,"
in its edition of March 9, 1907, publishes editorially an article
entitled "The Paranoia Question," explaining that the reason for
writing the article is "the absorbing interest taken in the Thaw
trial." Whatever this reason may mean, ic is unintelligible to us
in so far as it relates to the contents of the article, and we shall
not attempt to consider it. It is further stated that "fifteen years
ago the European institutions were filled with patients thought by
able alienists to be suffering from paranoia, while today in many
of the same institutions, perhaps even with the same directors,
one cannot find a paranoiac without the aid of a magnifying
glass." It is further stated that in former times "the admissions
of patients with 'paranoia' have been as high as from seventy to
eighty per cent."
We regret to say that our contemporary's estimate of the num-
ber of admissions of "paranoia" cases in European institutions
does not agree with the personal experience of the editor of this
publication in some of the leading European institutions. In
studies extending over a period of many years in the Ste. Anne
EDITORIAL. 83
Asylum, Paris, for instance, we found only a very few cases of
paranoia ; and the reading of hundreds of histories of cases, dating
thirty years back, recorded in the handwriting of master psychia-
trists, has failed to reveal any overwhelming number of paranoia
cases; in fact, only a very few such cases could be found, and
certainly the institution was not anywhere near being "filled"
with paranoia cases and did not contain ''from seventy to eighty
per cent." of such cases.
Our esteemed contemporary's attempt at elucidation of "the
paranoia question" seems to us to be too "raw" to be considered
seriously, as its main source of information on the subject seems
to us to have been found in pp. 200-210 of the American edition of
Mendel's "Text-book of Psychiatry." And from the knowledge
apparently culled from these small 8-vo pages our esteemed con-
temporary attempts to define what paranoia is, — giving an array
of terms such as "paranoid," "mild paranoia," "dementia precox,'*
"phobias," "delusional states following alcoholism, morphinism,
cocainism," "persecutes-persecuteurs," "chronic systematized
paranoia with recovery," etc., etc., — all of which does not indicate
to us that our esteemed contemporary has any claim to authority
in its attempt to throw light on mental diseases in general and
on chronic incurable paranoia in particular. But what is more
interesting in this matter is the very fact that anything written
on paranoia in a German work (American edition) should lead
the apparently uninitiated into such a confusion of terms and
terminology in mental diseases. Indeed, our esteemed contem-
porary complains that m English and American sources there "is
a lack of definition of what the various writers themselves mean
by that term" (paranoia). This last statement is certainly the
most intelligible one made by our esteemed contemporary on the
"paranoic question," and we cheerfully undertake the task of
defining what paranoia is, or rather, — what paranoia is not.
Paranoia is not anything in the shape of mental diseases men-
tioned in the above named article on "the paranoia question."
Paranoia is not "those mild insanities in which various 'phobias,'
fixed ideas and obsessions are features, developing on a psycho-
pathic foundation," in which delusions of persecution are very
frequently encountered.
. For a splendid clinical picture of "phobias," obsessions and
impulses, with or without accompanying delusions of persecution,
and with or without accompanying alcoholic delirium, we refer
to Magnan's "Recherches sur les centres nerveux," or to the arti-
cles published in English, in this Journal, Volume I, Nos. 4-5,
and entitled "A Clinical Study of Morbid Obsessions and Im-
pulses."
84 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2.
Paranoia is not a disease of ''post-infection and post-toxic
forms."
Paranoia is not an acute "paranoid" disease.
Paranoia is not dementia precox.
Paranoia is not a "maniac depressive" disease.
Paranoia is not a "toxic secondary paranoia."
Paranoia is not the delirium of the persecutes-persecuteurs.
Paranoia is not a curable disease.
For a clear clinical picture of a persecute-persecuteur and of
paranoia (chronic delusional insanity of systematic evolution)
we refer to Magnan's work quoted above as well as to the papers
entitled "Suicidal and Homicidal Acts, — their Clinical Aspects
and Medico-Legal Significance," published in this Journal, Vol.
V, Nos. I, 2-3 and 4-5. The reading of these papers may also
yield definite clinical notions on the various systematized delirium,
whether accompanied or not accompanied by obsessions, or im-
pulses, or alcoholic, morphine, cocaine or other intoxications.
Paranoia is essentially an evolutional disease, in the sense so
well crystallized by Magnan more than fifteen years ago: it has
four distinct stages of evolution: i, — period of incubation; 2, —
period of delusional interpretations ; 3, — delusions of grandeur
and 4, — period of dementia.
This disease is incurable even when the period of dementia
is delayed for many years.
There is no other affection in the scale of mental diseases that
has these characteristics.
Paranoia, consequently, is not anything in the shape of those
mental diseases with which our esteemed contemporary confounds
it.
And as we read our contemporary's appreciation of what para-
noia is — in the eyes of various authors — we forcibly call to mind
Cuvier's reply to his friends' definitions of a crab :
"A crab, — a small red fish, which walks, backward."
"Perfect, gentlemen," said Cuvier, "perfect, — only I will make
one small observation in natural history : the crab is not a fish, it
is not red and does not walk backward. With these exceptions
your definition is admirable."
Similarly, we repeat, that paranoia is not "abortive paranoia,"
nor "phobia," nor "fixed ideas," nor the delirium of the perse-
cute-persecuteur, nor systematized delusions following alcoholism,
morphinism, cocainism or infection, nor "paranoid" insanity, nor
dementia precox, nor, we repeat once more, anything in the shape
of the mental diseases enumerated in the article presumably in-
tended to elucidate the "paranoia question." With these excep-
tions, our contemporary's definition of paranoia is admirable.
EDITORIAL. 8S
While a good deal of confusion seems to characterize some
German classifications of mental diseases, the fundamental under-
standing of the term ''chronic incurable paranoia" is the same in
all classifications of the leading psychiatrists. Thus, in Dr. Rou-
binovitch's work entitled "Des varieties cliniques de la folic en
France et en Allemagne," may be found the following compara-
tive terminology in psychiatry :
"Paranoia of the Germans corresponds to all the systematized
deliriums of the French. These systematized deliriums include the
systematized delirium of Lasegue, chronic delusional insanity of
systematic evolution of Magnan, delirium of the persecutes-per-
secuteurs of Falret, polymorphous delirium of sudden onset, of
short duration and curable, of the degenerate, etc. The doctrine
regarding the majority of these systematized deliriums is the same
in France and in Germany. M. Magnan excepts chronic delu-
sional insanity of systematic evolution, which, according to him,
is never connected with hereditary or acquired predisposition,"
We refrain from quoting any details, but the statements are
substantially to the effect that Krafift-Ebing recognizes a chronic
and incurable form of paranoia ; that Schuele's doctrine on chronic
paranoia (which he terms Wahnsinn) is substantially similar to
that of Krafft-Ebing. Mendel's chronic paranoia is equivalent
to Magnan's chronic delusional insanity of systematic evolution.
And, we add, in the United States, the term paranoia has always
been used in the sense of a chronic, progressive and incurable
disease.
From this bird's-eye view of psychiatric terminology as it is
used by the leading French and German alienists, ic is evident that
there is a uniformity in the conception of chronic incurable para-
noia. But as is pointed out in the opening lines of the para-
graph quoted, — the Germans do create a considerable confusion
by their application of the term paranoia (without the specific
qualification — chronic incurable) to all systematized deliriums of
the French.
To the cosmopolitan student in psychiatry the French, and
notably Magnan's, classifications of mental diseases stands out
pre-eminently because of its adherence to clinical facts, its desig-
nation by terms that carry a clinical meaning with them and its
great simplicity of grouping. The German terminology, on the
contrary, totally lacks in simplicity in the name of the disease,
and seldom, if ever, hints at the clinical picture of the affection.
Magnan classifies all mental diseases of the degenerate in one
large group, the subdivision of which clearly indicate the clinical
picture of the affection, as for instance : — episodic syndromes
86 JOURNAL OF MENTAL PATHOLOGY. Vol, VIH, No. 2.
(obsessions and impulses, etc.), systematized or unsystematized
delirium (with or without disturbances of the general sensibility),
simple or polymorphous, accompanied or not accompanied by ac-
cidental delirium of alcoholic, morphine, cocaine or other intoxi-
cations, etc., etc. ; coexistence of obsessions and impulses and the
various deliriums, etc., etc.; then come the presecutes-persecu-
teurs; the circular and recurrent forms of insanity; the neuroses
(epilepsy, hysteria, etc.) ; insanities of organic nature (general
paralysis of the insane, etc.). Chronic delusional insanity of sys-
tematic evolution (or paranoia) is in a group by itself, occurs in
subjects free from hereditary or acquired predisposition and is
progressive and incurable.
This classification, based on clinical facts, is as simple as it is
free from such confusion of terminology as the German classifica-
tions necessarily suggest by their indiscriminate application of the
term paranoia to all systematized deliriums.
Our own study of insanity leads us to consider Magnan's
classification far clearer and truer to mental clinic than is any
other in existence. It seems to us reasonable, therefore, that we
should adopt his classification in the United States, where ad-
herence to facts and clearness in all work is so highly prized — and
justly so.
Many of our foreign colleagues eminent in psychiatry and
neurology have often remarked that in France the patient con-
ducts the clinic — by his clearness of expression and construction
of language, leaving to the clinician the mere perfunctory task
of labeling the disease. In Italy or Germany it is the physician
who "drags out by the ears," so to speak, the patient's statements
as to his complaint, suggesting words, sentences and whole para-
graphs to the patient in his endeavor to make a verbal picture
of his ailment.
Those familiar with clinics in different countries claim that the
clearness of the French language explains the French patient's
ability to give a precise description of his disease. There is, per-
haps, truth in this theory. And the clearness of the French
terminology is, no doubt, the result of this quality of the French
language.
Terminology, after all, is nothing but a language robed in
technicalities. If, then, the French have the gift of supplying
the clearest technical names of mental diseases, we should, per-
haps, accept the French classification of mental diseases.
Certain it is that we should be the gainers if we accepted Mag-
nan's classification.
Editorial. 87
THE "SIMPLIFIED EXPERT ALIENIST."
The business of the ''simpHfied expert ahenist" consists in
simpHfying the science of psychiatry. His definitions of mental
derangements are strictly sui generis and cannot, therefore, be
found in any of the writings of standard authors or in standard
dictionaries. Such terms as ''paranoia" or "chronic delusional
insanity of systematic evolution," or other terms designating
chronic and incurable mental affections must be wholly excluded
from his vocabulary. The field of activity of the "simplified ex-
pert alienist" is the courtroom, where he may appear for the pur-
pose of making it possible either for sane gentlemen murderers to
escape the penalty of the law, or for chronically insane gentlemen
murderers to escape being landed in an asylum for insane crim-
inals.
The "simplified expert alienist" may be fully informed on the
law's provision regarding insane criminals or criminal insane.
In the State of New York, for instance, this provision, relative
to crimes committed by insane and trial of the insane, is embodied
in Section No. 20 of the Penal Code and reads as follows :
"An act done by a person who is an idiot, imbecile, lunatic or
insane, is not a crime.
"A person cannot be tried, sentenced to any punishment or
punished for a crime when he is in a state of idiocy, imbecility,
lunacy or insanity so as to be incapable of understanding the pro-
ceeding or making his defense."
Such subjects are to-day committed to asylums for criminal
insane.
If the "simplified expert alienist" undertakes to aid an insane
gentleman murderer in his endeavor to spend his days out-
side the enclosure of an asylum for insane criminals, he may
so simplify the nomenclature of mental diseases that such terms
as idiocy, imbecility, paranoia and other specific terms indicative
of incurable mental diseases will be non-existent to him. And
when hard pressed by everwhelming evidence for an opinion, he
may specify the insane gentleman's mental status before the com-
mission of the murder about as follows :
"Not perfectly healthy condition," but not insane; "unstable
mentally but not insane"; "not lasting mental state but not in-
sane"; "pathological suspect but not insane"; "on border line of
insane instability and normal state but not insane." All these and
similar definitions may apply to the gentleman murderer's mental
status before the commission of the murder. At the very moment
of the murder, the insane gentleman murderer may be found, how-
ever, to be suffering from a "brain storm" or a "brain explosion"
and — is absolutely insane. But after the commission of the crime
and at the time of the trial for murder, the insane gentleman mur-
derer is perfectly sane.
88 JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 2.
Thus may the distinctive science of the/'simpUfied expert alien-
ist" enter as evidence in a murder trial. He further may fortify
the value of his clinical conceptions of mental diseases by impress-
ing upon the court the fact that he neither accepts nor agrees
with any of the standard authors' appreciations of mental de-
rangements, and his sui generis nomenclature must, therefore,
be the only one applied to the case in hand. He may then manage,
by virtue of the "rule of evidence," to keep from being kicked out
of court as an imposter attempting to aid and abet crime and crim-
inality and to unload dangerous homicidal insane gentlemen on a
defenseless public.
Difficulties in upholding the value of such a "simplified" nomen-
clature of mental diseases may not have any deterring effect on
the energies of the "simplified expert alienist." If, trapped by
the people's attorney, he is forced to admit that the insane gentle-
man murderer is suffering from a chronic and incurable mental
affection, the "simplified expert alienist" may still remain un-
daunted but be spurred on to further "stunts" in the simplification
of the nomenclature of mental diseases; if the insane gentleman
murderer did suffer from a chronic disease of the mind, the afflic-
tion may have manifested itself only in the shape of "outbursts,"
"brain storms" or "brain explosions" that came on at moments
when the gentleman murderer was going to bed late at night and
which left him early the following morning in a perfectly lucid
mental state.
Now, can there be any simpler aspect of chronic mental dis-
orders?
In fact, the "simplified expert alienist" may declare under
oath having seen and studied cases of, say, dementia precox (a
variety of insanity that may "burst" upon the victim at any time
between the period of childhood and the first centenary birthday)
that began, in repeated "outbursts," while the sufferer was enjoy-
ing the first pleasant dream of his night's sleep and left him early
the following morning in a perfectly lucid condition of mind.
Not every psychiatrist is fortunate enough to observe such
somnambulistic onsets and so sudden a disappearance at various
times of a chronic mental affection; but the "simplified expert
alienist" may be the exception to this rule.
These fortunate circumstances of the "simplified expert alien-
ist," combined with the opportunity afforded by the "rule of evi-
dence" may make it possible for insane gentlemen murderers to be
foisted on a defenseless public. Besides, to the "simplified expert
alienist" is due the credit of widening and enlarging the oppor-
tunities for applying this newest "outburst" of medical testimony
in murder trials.
INTERNATIONAL CONGRESS OF NEUROLOGY AND PSYCHIATRY. 89
We earnestly hope, therefore, for the sake of equity, public
safety and common decency that the present "rule of evidence"
may be changed in the near future and so perfected as to make it
an act of justice to the public on the part of the people's attorney
to kick out of court the "simplified expert alienist" if he happens
to appear therein in the role we have described, and neatly to kick
him into jail if he happens to deliberately attempt to aid and abet
crime, criminality and criminal acts.
International Congress of Psychiatry, Neurology and
Psychology, to Be Held at Amsterdam, Holland, September
2 TO 7, 1907. — This congress will be held under the auspices of
Queen Wilhelmina and her royal consort, Prince Hendrick, of the
Netherlands. Dr. G. Jelgersma, Professor of neurology and
psychiatry, University of Leyden, is the President of the congress ;
Dr. W. P. Ruijsch, Vice-President; Professor VanDeventer and
Dr. G. A. M. vanWayenburg, General Secretaries; Dr. A. Th.
Moll, General Treasurer.
The American committee of this congress is constituted as
follows :
New York: Drs. Carlos F. MacDonald, William Mabon,
Charles W. Pilgrim, M. G. Schlapp, W. B. Pritchard, Louise G.
Robinovitch.
Philadelphia: Drs. S. Weir Mitchell, John K. Mitchell,
Charles K. Mills, William G. Spiller.
Providence, R. I.: Dr. G. Alder Blumer.
Boston, Mass. : Prof . William James.
Madison, Wis. : Prof. Joseph Jastrow. -^
Chicago, III.: Dr. Hugh Patrick.
St. Louis, Mo. : Dr. C. H. Hughes.
Montreal, Canada : Dr. Th. Burgess.
Price of subscription 20 francs. Subscriptions should be ad-
dressed to the General Secretary, Prinsengracht, 717, Amster-
dam, Holland.
The Seventeenth Congress of Alienists and Neurolo-
gists OF France will be held in Geneva-Lausanne, August, 1907.
Subscriptions should be addressed to Dr. Long, 6, Rue Constan-
tin, Geneva, Switzerland.
The XVIth International Medical Congress will be held
in Budapest, Hungary, August 29th to September 4th, 1909.
A New Journal of Psychiatry. — "Sovremennaja Psychia-
tria" is the name of the new Russian monthly publication, that
appeared in Moscow last month, under the direction of Drs.
Soukhanofif, Gannoutchkine and others.
BOOK REVIEWS.
Woman. A Treatise on the Normal and Pathological Emo-
tions of Feminine Love. For Physicians and Students in Medi-
cine. With 122. drawings in the text. By Bernard S. Talmey,
M.D., Gynecologist to the Metropolitan Hospital and Dispensary.
The Stanley Press Corporation, Publishers, New York. The title
sufficiently indicates the contents of this small volume of 228
pages. The author explains in the preface that this is not an
original work, but is based on a number of works on psychology
and psychiatry of sex and sexuality. The chapters on the history
of love present interesting facts on love worship, showing that
among the ancients the passion of love and the fervor of religion
were closely interwoven. Sexual excitation and religious fervor
in Christianity is touched upon. Some space is devoted to the
description of normal sexuality, its use, abuse and abstinence.
The chapters on the pathology of sexuality include : sexual anes-
thesia, orgasmus retardatus, orgasmus precox, hyperesthesia or
erotomania, nymphomania, masturbation, incest, masochism, sa-
dism, fetichism, homosexuality, sexual inversion, and zooerastia.
Essentials for a happy union are indicated and the hygiene relat-
ing to sexual practices is considered. The author claims that
civilization is daily forcing upon society various means for sexual
excitation : the modern theater, public balls, at which young girls
are allowed to dance with men, the modern novels, style of dress
in woman and many other factors are powerful causes of sexual
excitation.
L'Hysterie et la Neurastheaie Chez le Paysan. By Dr. Ter-
RiEN, Director, Maison de Sante, Doulon-les-N antes. J. Sirau-
deau. Publisher. Angers, 1906. Hysteria and neurasthenia are
prevalent among the peasants in France. The author's personal
experience warrants his conclusion that hysteria is far more
prevalent am.ong the peasants than it is among city folks. Alco-
holism of the parents at the time of conception of their offspring
is mainly responsible for this trouble. Superstition as it is incul-
cated in the peasants' minds by religious teaching is another pow-
erful factor in the development of the affection. Hysteria is
defined as being a disease of persuasion — the subject persuades
himself that he has paralysis, etc., and the origin of hysteria is
heredity : one does not become hysterical but is born such. Numer-
ous personal cases of hysterical paralysis of years' duration are
cited, which the author cured within a few seconds by suggestion.
His success with these deformed subjects was so marked that at
BOOK REVIEWS. 91
one time he was accused of using occult science in treating the
ailments. Of all the forms of hysteria that accompanied by con-
vulsive manifestations is the most difficult to treat. Neurasthenia
is frequent among peasants, but is less so than among city people.
The peasant's susceptibility and imitative power is marked, and
the physician should be guarded in his tests for hysteria; simple
but effective tests are indicated.
The little volume is the result of many years' practice among
peasants as well as among the highest classes of society, and the
author's facilities for a comparative study in this field of work
lends great importance to its clinical value.
L' Opera Di Cesare Lombroso Nella 5chienza e Nelle Sue
Applicazioni. Scritti di: G. Amadei, G. Antonini e V. Tirelli,
L. Borri, E. Bozzano, S. de Sanctis, L. EUero, G. C. Ferrari e
E. A. Renda, L. Ferriani, E. Ferri, E. Florian, B. Branchi, G. A.
van Hamel, H. Kurella, A. Loria, C. E. Mariani e E. Audenino,
A. Marro, E. Morselli, A. Niceforo, M. Nordau, S. Ottolenghi,
L. Rancoroni, G. Sergi, A. Severi, S. Sieghele, A. Tamburini and
P. Tarnovsky. Preface by Professor Leonardo Bianchi. Fra-
telli Bocca, Publishers, Turin, 1906. — This work was presented
to Professor Lombroso on the occasion of the celebration of his
jubilee. In the preface to this work Professor Bianchi gives gen-
eral outlines of Professor Lombroso's achievements in the do-
main of criminal anthropology and says that what Charcot was
to France in Neuropathology, Lombroso is to Italy in criminal
anthropology; that Lombroso's teaching has withstood many
unfounded attacks, has triumphed and will triumph still further
with the better and more complete understanding of his teaching:
here and there some exaggerations in his teachings have to be
overlooked; but the Lombrosian school has come to stay. The
various authors, whose names are mentioned in the title of this
work consider Lombroso's works in relation to the following
subjects: general anthropology; degenerative characteristics in
man; normal and pathological psychology from the standpoint
of the educator; supernormal psychology; application of experi-
mental methods in the study of psychiatry; psychiatric noso-
graphia; the theory on genius; pellagra; cretinism; legal medi-
cine; forensic psychiatry; criminal anthropology; biological sig-
nificance of degeneracy ; prison discipline before and after Lom-
broso; juvenile delinquincy; relation to sociology and to collective
psychology ; Pinel and Lombroso ; the evolution of Lombroso ;
Lombroso's scientific courage and scientific philosophy. Con-
cluding the article on Lombroso's influence on scientific philoso-
g2 BOOK REVIEWS.
phy, Prof. Morselli points out some of Lombroso's ideas on mind
and matter: all animal force is a manifestation and effect of its
material property ; the physiology of a cell is the basis of its psy-
chology, and experimental anthropology confirms the material
basis of thought. A list of Lombroso's works during 1851-1905
is appended to this volume of 405 large octavo pages.
Text-Book ol Psychiatry. A Psychological Study of Insanity
for Practitioners and Students. — By Dr. E. Mendel, A. O. Pro-
fessor in the University of Berlin. Translated, edited and enlarged
by William C. Krauss, M.D., President Board of Managers Buf-
falo State Hospital for Insane. 311 pages. Crown Octavo.
Price, $2.00. F. A. Davis Co., Publishers. The author
states in the preface to this work that it is intended for
students and physicians preparing to pass an examination
in psychiatry, so that the content of the volume is neces-
sarily elementary. The first part of this wofrk, diealing
with elementary notions on psychology and psychiatric symp-
toms takes up nearly one-half of the book. These elementary
notions answer the purpose for which they were written. The
description of individual mental diseases is less satisfactory, how-
ever, as the author has excluded clinical histories of individual
mental diseases, substituting for these general descriptions. To
the student and physician preparing to pass an examination all
delusions, hallucinations and deliriums are alike, and a general
description of a mental disease, or rather of many mental diseases,
fails to make a special impression on his mind from the standpoint
of a differential diagnosis ; where a general description fails in
this respect, a specific clinical history of a given mental disease is
apt to leave a more definite impression on his mind as to the
picture of the disease described ; and besides, such clinical histo-
ries are valuable aids to the student who can refer to them on
leaving his clinic. The whole part of this work dealing with gen-
eral descriptions of mental diseases could be replaced by clinical
histories of the respective diseases — to the student's advantage.
The classification of mental diseases used in this work is con-
fusing especially to beginners ; under the heading of paranoia, for
instance, are described obsessions and impulses, all the systema-
tized deliriums of the insane as well as incurable paranoia prop-
erly speaking. The descriptions in general are colorless and lack
clinical individuality, as may be judged from the five pages
devoted to the description of "rudimentary paranoia" — meant for
that of obsessions and impulses: a clinical history of obsessions
and impulses, well presented and taking up only one page would
BOOK REVIEWS. 93
certainly leave a more concrete notion in the student's mind as
regards the disease than does the description taking up five pages
on the same subject. The same may be said of all the diseases
described, and especially of alcoholic delirium and of post epileptic
delirium, both of which lend themselves admirably to description
in clinical histories. The translation is somewhat peculiar in word-
ing, terminology and construction : ''imperative concepts," for
instance, is used instead of obsessions and impulses. Besides the
fact that ''concept" is an obsolete word, the term "imperative con-
cepts" may not be substituted advantageously for obsessions and
impulses, which give an exact word picture of the mental trouble
as well as designate individually a state characterized by obses-
sions only, or one of obsessions ending in impulses. "Twilight
state," for unconscious or subconscious state, is another of the
vague terms used ; and such expressions as "The state of dementia
is accustomed in this type to appear earlier than," etc. (p. 206),
are not calculated to please the ear of the English speaking public.
Hampa Alro-Cubana. Los Negros Brujos. Apuntes Para wn
Bstudio de Etnologia Crltninale. With 48 illustrations and a
preface by Prof. C. Lombroso. By Ferdinando Oritz. Libreria
de Fernando Fe, Madrid, 1906. — This volume contains an
exhaustive study on ethnogeny in Cuba, and the religion, morality,
customs and superstitions of the Cubans. Numerous illustrations
are presented of their idols, devils and symbols employed in the
practice of sorcery. Sorcery is most prevalent in Cuba, especially
in those towns which are not frequented by civilized visitors.
Religion is closely woven together with sorcery and with daring
criminality that is often expressed by manslaughter. Sorcery
often supplants the art of medicine as well as administration of
law. The epileptic, the insane, the pregnant girl and subjects
with all sorts of afflictions or grievances unhesitatingly apply to
the sorcerer for advice and treatment. Manslaughter is often
the result of these dealings. The laws against these practices
are strict but rather ineffectual. The author cites a number of
criminal cases of this kind, giving dates and indicating the papers
from which they are quoted. The author claims that subjects
of Spanish origin represent the higher type of civilization and
intellectuality, while those of African origin are the lowest in
intellect as well as in morality. These latter subjects are particu-
larly given to the practice of sorcery and criminality. A chapter
is devoted to the suggestion of measures for the suppression of
these criminal practices.
94
BOOK REVIEWS.
Nearologie, Psychiatrie et Anthropologie Criminelle. Section
VII of the report of the XVth International Congress of Medi-
cine, Lisbonne, April 19-26, 1906. The following are the titles of
papers contained in this volume : Physiopathologie de I'appareil
medillaire sensitif (Les voie de la sensibilite dans la mobile de
rhomme) — M. Grasset. Le goitre exophthalmique considere
comme maladie et, comme syndrome — Haskovec. Nature et evo-
lution de la catatonic — Simon. La paranoia legitime. Son origine
et nature — Peixoto and Moreira. Formes et pathogenic de la
demence precoce— Tschisch. Nature et physiologic pathologique
de la tabes — Ferrier. Les lesions cerebrales dans les psychoses
d'origine toxiques — Mott. Le goitre exophthalmique considere
comme maladies et comme syndrome — Machado. Les lesions
cerebrales dans les psychoses d'origine toxiques — Ballet and
Laignel-Lavastine. Nature et physiologic pathologique du
tabes — Eulenburg. Reforme penale au point de vue anthro-
pologique et psychiatrique — Van Hamel. Prophylaxis and treat-
ment of criminal recidivists — Sutherland.
A Text-Book of Mental Diseases. By Vladimir Serbski, Pro-
fessor of Psychiatry, University of Moscow. Pp. 573, large 8vo,
Price, 3.50 roubles. Published by A. A. Levenson, Moscow, 1907.
The first part of this work is devoted to the study of general psy-
chopathology and the following subjects are treated of: the dis-
turbances of the intellect, affective sphere, will power, conscious-
ness, metabolic changes, etiology of mental diseases, pathological
anatomy of mental diseases, method of examination^ diagnosis,
treatment and prognosis of mental diseases. The second part of
the work is devoted to the study of individual forms of mental
affections.
Professor Serbski is well known to the psychiatric world and
we are all familiar with his erudition in psychiatry. In this, as
in all his works, he is broad — presenting the views of the leading
psychiatrists of our day — in Russia, Germany, France, Italy and
elsewhere. All the schools are represented in this work — Krafft-
Ebing, Kraepelin, Magnan, Korsakoff, etc., etc. The work is one
of marked value, and Prof. Serbski deserves much credit for this
exhaustive and up-to-date volume on mental diseases.
I Principl Pondamentali Delia Antropologia Crlminale.
Quida per I Qiudizi fledico-Forensi Nelle Questione di Impu-
tabiiita* Giuseppe Antonini, Libero Docento in Psichiatria, Di-
rettore del Manicomio Provinciale di Udine. Ulrico Hoepli, Pub-
lisher, Milan, 1906. Price, 2 lire. This is a compendium on crimi-
BOOK REVIEWS. 95
nal anthropology. The latest views on criminal anthropology are
presented, the criminal being looked upon as a diseased member
of society who needs medical treatment. The advisability of
building special asylums for the criminal insane and insane crimi-
nals is considered. Part of this little volume is devoted to the
consideration of the various forms of mental disease.
Psychology Applied to Medicine. Introductory Studies. — By
David W. Wells, M.D., Lecturer in Mental Physiology, Boston
University Medical School. Illustrated, 141 pages, i2mo. Price,
$1.50. F. A. Davis Co., Publishers. This is an elementary work
on psychology written especially for the use of medical students.
The subjects treated of are reason and instinct, habit, sensation,
experimental psychology and hypnotism. The author apparently
endorses reformed spelling, as he uses the words thru, altho, and
thoroly.
Cesare Lombroso. Appunti Sulla Vita, le Opere. — By Paola
AND GiNA Lombroso. Fratelli Bocca, Turin, Publishers, 1906.
This volume consists of a biographical sketch of Professor Cesare
Lombroso by his two gifted daughters, one of whom, Gina, is
herself a physician. The description of Professor Lombroso's
early struggles as a student and as a Jew making his way against
all odds and racial persecution is of more than passing interest.
His scientific career is too well known to the profession to need
any description; but the intimate knowledge of his private life
enables the two biographers to lend a touch of charm to the
whole volume, as they do not refrain from citing many humorous
incidents and anecdotes relating to Professor Lombroso's inti-
mate life.
The volume was presented to him last year, on the occasion
of the celebration of his jubilee.
Les Therapeutiques Recentes Dans les Maladies Nerveuses.
—By Prof. M. Lannois and Dr. A. Porot. J. B. Balliere et Fils,
Publishers. Paris, 1907. Pp. 96, in-i6°. Price, 1.50 francs. The
treatment of nervous diseases is considered under the following
headings: lumbar puncture, re-education and tics, injection of
mercurial preparations in nervous diseases of syphilitic nature,
arsenical treatment of chorea, injection of gases or air in the
treatment of neuralgia and neuritis. Although small in size this
volume contains valuable reports of clinical cases in which these
various forms of treatment have been tried.
96 BOOK REVIEWS.
Ueber die Psychologie der Dementia Praecox. — By Dr, C. G.
Jung, Privat Docent in Psychiatry, Zurich. Carl Marhold, Pub-
lisher. Price, 2.50 marks. This volume contains an exhaustive
study of the psychology of dementia precox. The German lan-
guage lends itself particularly well to speculative theories in
psychology and the author presents a full measure of such the-
orizing in this work. After a lengthy consideration of the psy-
chology of dementia precox he draws a parallel between this
disease and hysteria. The volume is full of interest and shows
the author to be well versed in the subject of which he treats;
the Germanic tendency to put psychiatry on a solid basis of psy-
chology is much in evidence in this work.
Ueber Robert Schumanns Krankheit.— By P. J. Moebius. Carl
Marhold, Publisher. Price, 1.50 marks. A detailed review of
Schumann's mental disturbances is presented, the study being
based on authentic documents and letters relating to the com-
poser's spells of mental disease as well as to his last illness. The
author concludes that Schumann's mental trouble was intimately
connected with his insane heredity, but there is little, if any, proof
that general paralysis of the insane was added to his hereditary
mental affection from which he suffered at various times.
Ibsen's Nora vor dem Stralrichter und Phychiater.— By Dr.
E. WuLFFEN. Carl Marhold, Publisher. Price, 1.20 marks. Ibsen's
"Nora" (the "House of Dolls") presents a scientific illustration
of feminine hysteria — with its moral depravity, selfishness and
criminality. The legal case which Ibsen shapes in this play is
perfect in its construction as well as in its complicaton. The
author remarks in this monograph that Ibsen took great interest
in medical studies. This may explain Ibsen's knowledge of the
psychology or rather psychiatry in hysteria.
Was sind Zwangsvorgaenge? — By Dr. Bumke, Privfit-Docent
Freiburg Psychiatric Clinic. Carl Marhold, Publisher. Price, 1.50
marks. The author reviews the use and abuse of the terms
Zwangsvorgaenge, Zwangsvorstellung, Zwangszustand, Zwangs-
affekten, etc. ; many psychiatric disturbances have been designated
by these various terms without any clinical foundation for such
designations. If the terms are meant to apply tO' diseases desig-
nated by Magnan as "obsessions," it would be advisable to accept
Moebius's suggestion to substitute for them the term "Besessen-
heit."
The Journal of Mental Pathology
Vol. VIII 1907 No. 3
THE DEVELOPMENT OF THE MODERN CARE
AND TREATMENT OF THE INSANE, AS
ILLUSTRATED BY THE STATE HOSPI-
TAL SYSTEM OF NEW YORK.*
By Carlos F. MacDonald, A.M., M.D.
Ex-President New York State Commission In Lunacy ; Emeritus
Professor of Mental Diseases and Medical Jurisprudence,
University and Bellevue Hospital Medical College,
New York.
Delegate from the United States Government to the International
Congress of Neurology^ Psychiatry , Psychology and
Care of the Insane, Amsterdam, Holland, Septem-
ber 2-y, 1907, and Chairman of the American
Delegation to the Congress.
The subject of my remarks on this occasion — the development
of the modern care and treatment of the insane, as illustrated
by the State Hospital system of New York — is naturally sug-
gested by one of the principal objects for which this body of dis-
tinguished representatives of medical science are assembled in
international congress, namely, the advancement of psychiatry, of
which branch of medicine the care and treatment of the mentally
afflicted is an integral part. The pertinence of my theme was
further suggested by recollections based on personal observations
and experiences since I entered upon the work of caring for the
insane, in 1870, during which time it was my privilege to witness
the progress and to participate to some extent in the efforts made
in my country to reform the methods of caring for the insane,
especially as regards the use of mechanical restraints and punish-
* Read at the International Congress of Neurology, Psychiatry, Psy-
chology and Care of the Insane, held at Amsterdam, Holland, September
2-7, 1907.
98 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 3.
ments of various kinds, and the abolition of a barbarous system
of so-called ''county care" and the substitution therefor of the
modern hospital for the insane.
Among the many serious problems with which States and com-
munities are confronted to-day, there is probably none that rivals
in importance, whether viewed from a medical, social, economic
or philanthropic standpoint, that of securing, at a minimum cost,
proper care and treatment to the vast army of dependent sufferers
from that most serious, most dangerous and most far-reaching
in effect of all diseases known to medical science — insanity. But
above and beyond all this, the great fact remains that, in consider-
ing the subject of the care and treatment of the insane, the high-
est place should be given to its humane aspect. Aside from its
humane aspects, however, which must always be regarded as of
primary importance, since the claims of suffering humanity take
precedence of merely material or pecuniary policies, the financial
side of the problem involving, as it does, even under the most
economical methods, the expenditure of vast sums of money for
lands and buildings, with their equipment and furniture, besides
an enormous annual outlay for maintenance, repairs, renewals and
enlargements, may well command the most serious attention and
co-operation of the legislator, the political economist, the taxpayer
and the humanitarian.
Turning for a moment to a consideration of the humane side of
the question, it will be conceded that of all diseases which afflict
mankind, insanity is by far the most frequent, most widely preva-
lent, and most far-reaching in its effects, whether as regards the
interests of the afflicted individual, or of his family, or of the
commonwealth; that a vast m.ajority of its victims must, during
its existence, be deprived of personal liberty and removed from
their homes, to be cared for in institutions established and main-
tained at public expense ; that among the dependent insane are to
be found numerous representatives of all professions, trades, and
occupations, whose financial, social, and intellectual status may
have been of a high order, and most of whom were respectable,
self-supporting citizens — many of them taxpayers — ^prior to the
onset of their disease; that the commonwealth is in duty bound
to provide these dependent sufferers with suitable shelter, food
and raiment, together with means of occupation and diversion,
and competent medical care and supervision.
It need hardly be said that in the consideration of this question
humanity should have the first place, but it must also be admitted
that its economy must have a prominent place. Hence, it follows
that that policy ought to be pursued which will, first of all, secure
CARE AND TREATMENT OF THE INSANE.— Dr. MacDonald. 99
everything that is essential to proper care and treatment, and, at
the same time, Hmit the cost to such sums as the truest economy
for the State would suggest. In other words, the dictates of
humanity demand that the insane shall be amply provided with
everything which medical science has determined to be essential
to the recovery of those who are recoverable, as well as for the
proper care, comfort, and amelioration of those who remain un-
recovered. In fact, no system for the care and treatment of the
dependent insane can be successfully administered which is not
sustained in its ordinary operation by the highest order of human
emotions ; no system can be fairly regarded as good which directly
or indirectly relies upon the lowest order of these emotions.
Cupidity and self-interest should have no sway where suffering
humanity is concerned.
In support of the claim here indicated respecting the im-
portance of mental as compared with other diseases, mention may
be made of the trite facts that insanity is a disease which invades
all classes of society, and one from which no one can claim ex-
emption; that it involves to its victim, to his immediate friends,
and to the community, a wider range of interests than any other
disease. To the individual it involves a loss or perversion of rea-
son; also, in most cases, a loss of personal liberty, the loss of
control of his property and affairs, a disturbance or destruction
of his social and business relations, enforced separation from his
family, and, if his disease happens to take an unhappy form, it
involves great mental anguish and suffering, and, possibly, the
loss of his life through self-destruction or exhaustion: or, if the
case fails of recovery, it may involve in addition to these, a pro-
longed and often weary existence, which might properly be
termed "a living death." To the individual's family it involves
great anxiety and distress, occasioned by the sad spectacle of a
loved one with reason dethroned and the putting of this loved one
away in the care of strangers ; it also involves the stigma which
society unfortunately and wrongfully attaches to the taint of in-
sanity, and which is usually regarded by the relatives of the suf-
ferer as something akin to shame and disgrace. It involves,
frequently, a cutting off of the source of income, especially if the
afflicted one be the breadwinner of the family; also the added
expense of commitment to and maintenance in a hospital for the
insane ; and finally, it involves exposure of the lives and property
of the family to danger from the of times violent and destructive
tendencies of the patient. To the community it involves great
danger to life and property from the acts of homicidal and dan-
gerous lunatics ; also a large loss to the body politic by the with-
100 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 9.
drawal from the ranks of its wage earners of the earning capacity
of many thousands of individuals — substantially all of the insane
being adults and, for the most part, in the active and most pro-
ductive stage of life; and last, though by no means least, it
devolves upon the community an enormous burden of taxation
incident to providing and maintaining hospitals for the custody
and care of a vast army of insane people, there being to-day in
the State of New York alone more than 28,000 certified lunatics,
not to mention the large number of unapprehended, unrecognized
and so-called ''borderland cases" in all communities, that are liable
at any time to require medical care and attention.
With respect to its bearing upon the importance of the subject
from a pecuniary standpoint, mention may be made of the fact
that in the development of the wealth of the State the life of each
adult unit of a community has an estimated value of $200 per
annum, whereas, the average duration of insane life is about
twelve years and the average annual cost of properly caring for
an insane person in a public institution, including interest on in-
vestment, is in the United States about $200. This would indicate
a loss to the State of approximately $400 for each year that a
patient remains under care as a public charge. In other words,
if the average life of the insane is twelve years and the annual
per-capita cost of maintenance is $200, each insane person who
fails of recovery during this period represents a loss to the State
of $2,400 ; whereas, a sane person for a like period of time would
represent a gain of $2,400. But even though the individual con-
tribute nothing to the wealth of the State when sane, it would
still be in the interest of economy to provide for him when he
becomes insane, such environment and such treatment as will in-
sure every opportunity of restoring him to the ranks of the wage-
earners, or at least of enabling him to return to his home, and
thus relieve the public of the burden of his support. By restoring
a sick man to health we not only enable him to resume the sup-
port of his family, which otherwise might become a public burden,
but we pave the way for him to again become an industrial unit
in the community, whereby he may contribute his portion to the
public weal.
At the present time there are in the State of New York fifteen
State hospitals for the insane — thirteen for the ordinary insane
and two for insane criminals — and twenty-three licensed private
institutions for the insane. The whole number of committed in-
sane in the public and private hospitals of the State of New York
at the end of the fiscal year, September 30, 1906, was 28,302, di-
vided as follows: — men, 13,548; women, 14,754. The whole num-
CARE AND TREATMENT OF THE INSANE.— Dr. MacDonald. iqi
ber of insane in the State hospitals, including two hospitals for
insane criminals (960) on September 30, 1906, was 27,317. The
whole number of insane in licensed private institutions was 985.
The net increase for the year in all institutions was 895 ; in the
State hospitals, including the criminal asylums, the net increase
was 896. The number of resident medical and other officers in
State hospitals is about 300, and of attendants, nurses and other
subordinate employes, 3,500.
The cost of the State hospitals, for lands, buildings, equipments
and furniture, represents a permanent investment of more than
$26,000,000, while the average annual expenditure for their main-
tenance, exclusive of cost of repairs, renewals and enlargements,
is about $5,000,000. The average weekly per capita cost of main-
tenance for the last fiscal year being $3.53. This weekly rate is
somewhat higher than the average for the whole United States,
in which the number of insane is roughly estimated at 200,000.
If we estimate, even approximately, the cost of providing for
and supporting the insane of the entire civilized world upon this
basis, or even on a much lower one for some countries, the magni-
tude and importance of the subject at once becomes apparent.
The foregoing statement of facts and figures is here presented
merely for the purpose of calling attention by way of introduction
to the magnitude and importance of the disease under considera-
tion and as suggestive of the wide range of interests it involves,
whether viewed from a professional, sociological or economical
standpoint.
The first attempt on the part of the State of New York to pro-
vide State care for her insane was made nearly sixty years ago
when, in 1836, the Legislature, in response to a memorial from
the Medical Society of the State of New York, praying for the
establishment of a suitable State asylum for the insane, created
the State Lunatic Asylum at Utica, now the Utica State Hospital.
The institution, however, was not opened for the reception of
patients until January, 1843. The establishment of this asylum
was the first recognition by the State of New York of the prin-
ciple of State care. Prior to that time the insane poor, both acute
and chronic, were mostly cared for in county or town poorhouses
or in jails, there being substantially no other provision for them.
Provision was made in the original charter of the Utica Asylum
whereby patients who failed to recover after a certain period of
time, or who should be pronounced incurable, might be removed
to the county poorhouse, upon the superintendent's certificate that
the patient was "incurable" or "not likely to be benefited by fur-
ther treatment, and could probably be made comfortable in the
102 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 3.
poorhouse." This was a most inhumane provision, and one that
was continued in operation under certain modifications, though
with practically the same results, until the creation of the State
Commission in Lunacy in 1889, and the subsequent passage of the
State Care Act in 1890. So that, while the establishment of the
State Lunatic Asylum in Utica in 1836, was a practical recogni-
tion on the part of the people of the State of New York of the
principle of State care, its beneficence extended only to State care
for the acute or recent insane, while at the same time it coun-
tenanced, or at least tolerated, a system of county or poorhouse
care in its worst form by permitting the superintendent of the
State asylum, in his discretion, to transfer to county houses, under
the guise of incurability, the friendless, the violent and destruc-
tive, the filthy and infirm, and the feeble and helpless — the very
classes which, above all others, most need the fostering care and
protection of the State. This pernicious system continued for a
period of more than forty years, during which time the poor-
houses became filled to overflowing with mentally afflicted human
beings, who were accorded only the merest pretence of custodial
care and maintained in a spirit of parsimony whose chief appar-
ent ambition was to see on how small a pittance a body and soul
could be kept together. The keeper of one county asylum stated
to the writer with evident pride in 1889 — the year the State Com-
mission in Lunacy was created — that he maintained the insane
of his county at a cost of ninety cents a week, per capita, or less
than thirteen cents per day.
This accumulation of the insane in the county poorhouses and
in so-called "county asylums" which, excepting those in urban
districts, were destitute even of a nominal medical head, resulted
in their being treated as ordinary paupers, the character of their
malady being ignored or unappreciated, and they received no
more care or attention than was accorded to the sane paupers.
In other words, the insane were pauperized in the matter of food,
clothing, shelter and environment, as well as of proper medical
care and treatment. Experienced observers of mental disease, and
of the natural tendencies of its victims, will readily imagine what,
under such circumstances, the condition of the insane in the State
of New York must have been at that time, a condition best
described by the terms, misery, degradation, squalor, wretchedness
and neglect.
The standard of care in the State of New York at that time,
and its resultant conditions, are graphically portrayed in the fol-
lowing extract from a report made to the Legislature in 1864 by
the late Dr. Sylvester D. Willard, Secretary of the New York
CARE AND TREATMENT OF THE INSANE.— Dr. MacDonald.
103
State Medical Society, who, although not an alienist, was a hu-
manitarian, personally investigated the condition of the insane
poor in the various poorhouses, county insane asylums and other
institutions where the insane poor were kept :
"In some of these buildings the insane are kept in cages and
cells, dark and prison-like, as if they were convicts, instead of the
life-weary, deprived of reason. They are in numerous instances
left to sleep on straw, like animals, without other bedding, and
there are scores who endure the piercing cold and frost of winter
without either shoes or stockings being provided for them; they
are pauper lunatics, and shut out from the charity of the world
where they could at least beg shoes. Insane, in a narrow cell, per-
haps without clothing, sleeping on straw or in a bunk, receiving
air and light and warmth only through a rough, prison-like door ;
bereft of sympathy and of social life, except it be with a fellow
lunatic, without a cheering influence or a bright hope for the
future ! The violent have only to rave and become more violent,
and pace in madness their miserable apartments. These institu-
tions afford no possible means for the various grades of the in-
sane; the old and the young, the timid and the brazen, the sick,
the feeble and the violent, are herded together without distinction
as to the character or degree of their madness, and the natural
tendency is for all to become irretrievably worse. In some violent
cases the clothing is torn and strewed about the apartments, and
the lunatics continue to exist in wretched nakedness, having no
clothing and sleeping upon straw wet and filthy with excrement,
and unchanged for several days. * * * Can any picture be more
dismal ? and yet it is not overdrawn."
The publication of this report aroused public sentiment and
resulted in a second spasmodic effort on the part of the Legisla-
ture to provide for State care of the chronic insane by the estab-
Hshment, in 1865, of the Willard Asylum for the Chronic Insane,
now the Willard State Hospital, and subsequently, in 1879, the
Binghamton Asylum for Chronic Insane, now the Binghamton
State Hospital, to which it was proposed to transfer all of the
insane from the county poorhouse asylum where they had
accumulated in large numbers. This second era in lunacy legisla-
tion for State care largely failed of its object through delay on
the part of the State in providing sufficient accommodations for
this class, notwithstanding the fact that in the period from 1865
to 1889 seven State asylums — five for acute and two for chronic
cases — had been established. Owing to this lack of accommoda-
tion, the State asylums for the acute insane were permitted by
law to continue the pernicious practice of returning their unre-
104 "^^^ JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 3.
covered patients to the county poorhduses, some of which were
called ''county asylums." The inhumane practice of removing
these unfortunates from State asylum to poorhouse, usually at
the end of one year, continued under certain modifications, though
with practically the same results, for upward of half a century, or
until the creation of the State Commission in Lunacy in 1889, and
the enactment of the State Care law in 1890. Thus, while the
State had recognized the principle and, at least theoretically,
adopted the policy of State care for its dependent insane, it had
fostered a system of county care in its worst form and one which
pauperized substantially every patient who failed of recovery
after a year's residence in a State asylum.
It should be borne in mind that a large majority of the depend-
ent insane, of which the great bulk of our hospital population is
composed, are not paupers in any proper sense of the term. A
pauper is one who was a pauper and a public charge before he
became insane, whereas, the great mass of the inmates of our
State hospitals are persons who were self-supporting, respectable
citizens when overtaken by disease and as such they are clearly
entitled to receive the highest standard of care and treatment, to
the end that as many as possible may be restored to lives of use-
fulness and to the ranks of the bread-winners.
Another evil which sprang up in connection with this wretched
county care system, and which had become an integral part of it,
was a practice of receiving recent and presumably recoverable
cases directly from their homes, which was not only violation of
law, but a great moral wrong.
This deplorable condition of the insane in poorhouses and
county asylums at last became so acute that it attracted the atten-
tion of certain philanthropic people and especially of a charitable
organization known as the State Charities Aid Association, a
voluntary body, which in its visitation of county asylums and
poorhouses by local committees had become familiar with the
existing evils.
This association, although without legal authority to correct
the abuses which its local visitors reported, under the leadership
of the chairman of its Committee on the Insane, Miss Louisa Lee
Schuyler, began a reform agitation, through the public press, and
by personal appeals to Legislators, to the medical profession and
to other influential public-spirited citizens. This agitation, con-
tinued in the face of powerful opposition, gradually gained force
until it culminated, after two unsuccessful efforts, in the enact-
ment of the State Care law in 1890. Meanwhile, the Legislature,
having become convinced of the futility of enacting laws for the
CARE AND TREATMENT OF THE INSANE.— Dr. MacDonald. 105
improvement of the condition of the insane without providing
adequate legal machinery to enforce the same, passed a law, in
1889, creating a State Commission in Lunacy and clothing it with
practically plenary power in respect to the insane and the man-
agement of institutions for the insane, both public and private.
This Commission, over whose deliberations I had the honor of
presiding during the first seven years of its existence, consists of
three members, with the following required qualifications: A
physician of at least ten years' experience in the care and treat-
ment of the insane and in the management of institutions for the
insane; a lawyer of at least ten years' practice, and a layman of
good repute, all to be appointed by the Governor of the State,
with the concurrence of the Senate. My associate commissioners
were Hon. Goodwin Brown, lawyer, and Hon. Henry A. Reeves,
citizen, both of whom rendered invaluable service in organizing
the work of the Commission and putting the State Care law into
successful operation. The creation of this Commission gave a
powerful impetus to the State care movement. It promptly joined
hands with the State Charities Aid Association and others in their
efforts in behalf of State care and in the first year of its existence
(1889) it made a thorough examination of the county institutions
for the insane, twenty-one in all, in many of which the condi-
tions were found to be nearly as bad as those so vividly portrayed
in Dr. Willard's report. Most of the buildings were found to be
utterly unsuited to their purpose, both as regards their structural
arrangement and equipment. They also were woefully lacking in
respect to sanitary appliances, furniture, bedding, clothing, food
supplies, order and cleanliness, facilities for diversion and amuse-
ment, religious worship, nursing and competent medical super-
vision. In several instances disturbed and violent insane women
were cared for by male keepers who were devoid of any proper
training or experience in nursing the insane. Crude methods of
mechanical restraint and other forceful means of repression were
commonly resorted to to quell the violence and turbulence which
existed on every hand, and which, coupled with the general con-
ditions of confusion, disorder and untidiness that prevailed,
served to render some of these institutions veritable bedlams. In-
deed, so glaring were the defects found by the Commission on its
first inspection of these institutions that it immediately issued an
order declining to grant any further permission to county officials
tp care for their insane. In its first report to the Legislature the
Commission disclosed the wretched condition of these institutions
and their inmates and recommended the abolition of the county
care system and the transfer of all of the inmates of such institu-
I06 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VHI., No. 9.
tions to State hospitals, there to be maintained solely at the ex-
pense of the State. This report, which attracted wide attention
through the medical and secular press, it is generally conceded,
gave the death-blow to county care of the insane in the State of
New York. In response to the recommendation of the Commis-
sion, and despite an organized, vigorous and determined opposi-
tion on the part of county officials and their numerous sympathis-
ers, the Legislature, in 1890, passed and the Governor approved
an act, known as the State Care Act, which annihilated the county
care system and provided that all of the dependent insane of the
State shall be treated in hospitals established, maintained and
governed by the State. Of this law the American Journal of In-
sanity for April, 1890, speaks in the following language: "The
State Care Bill, providing State care for all the dependent insane
in the State of New York, became a law April 15, 1890. By sign-
ing this bill Governor Hill consummated one of the most signal
triumphs ever achieved by humanity in the State of New York.
All honor to those good men and women who have labored
zealously day in and day out for the past three years to bring
about this happy result. In the general rejoicing there will be
no caviling as to who is entitled to the lion's share of the credit,
though all must recognize the important part played in this great
reform by the State Commission in Lunacy." In this connection
it should be said that the Commission was sustained by the medi-
cal profession as a whole and by the unremitting efforts of the
State Charities Aid Association.
By the adoption of the State Care Act, the State of New York
not only emphatically reaffirmed its policy of State care, which
began in 1836, and which was extended in a half-hearted way in
1865, but unequivocally committed itself to the extreme and
logical limit of the principle, in fact as well as in theory, that the
dependent insane are the wards of the State, and that the interest
and maintenance of the insane should be confided exclusively to
the State ; while the terms of the act render it easily workable and
susceptible of unlimited extension to meet the increasing de-
mands which may from time to time be made upon it.
The important features of the State Care Act (Chap. 126, Laws
of 1890), and of acts supplementary thereto, may be briefly sum-
marized as follows : The abolition of separate institutions for the
chronic insane; the designation of all the public institutions for
the insane as State Hospitals ; the territorial division of the State
into hospital districts, and requiring that each hospital shall re-
ceive all of the dependent insane, both acute and chronic, within
its district ; providing for the erection on the grounds of the State
CARE AND TREATMENT OF THE INSANE.— Dr. MacDokald. 107
hospitals of additional buildings to accommodate the inmates of
county asylums, then numbering nearly 2,300; also requiring the
Commission, whenever deemed necessary to prevent overcrowd-
ing, to enlarge existing hospitals or to recommend the estabhsh-
ment of additional hospitals in such paits of the State as in its
judgment will best meet the requirements; requiring county
superintendents of the poor and other officials of similar jurisdic-
tion to properly prepare patients for removal to hospitals by see-
ing that they are in a state of bodily cleanliness and comfortably
clad in new clothing throughout and adapted to the season of the
year, in accordance with regulations made by the Commission;
providing that the removal of public patients from their homes
or from poorhouses shall be done by nurses sent from the hos-
pitals, and that female patients, unless accompanied by relatives,
must be removed by female attendants, the cost of removal in all
cases to be borne by the hospital; that after such patients have
been delivered into the custody of the hospital the care and con-
trol of them by county authorities shall cease ; that thereafter no
insane person shall be permitted to remain under county or mu-
nicipal care, but all such shall be transferred to State hospitals
without unnecessary delay, there to be regarded and known as
the wards of the State ; also prohibiting absolutely the return of
any insane person from a State hospital to the care of county
officials ; also providing that no money shall be expended by the
managers of a hospital for additional buildings or for extraordi-
nary repairs and improvements except upon plans and specifica-
tions approved by the Commission ; also, that no expenditure for
any other purpose shall be made by the hospitals except upon
itemized estimates approved by the Commission; requiring the
hospitals to submit to the Commission bi-monthly, itemized esti-
mates for their current expenditures, these estimates to be re-
vised by it as to quantities, quality and cost of supplies ; requiring
the Commission to classify the salaries and wages of officers and
employes of the hospitals on a basis of uniformity for similar
ranks and grades of employment; requiring uniformity in all
official records and forms used by the hospitals; providing for
the establishment of a Pathologic Institute to be maintained for
the benefit of all the hospitals, the director of the institute to be
appointed by the Commission after a special civil service ex-
amination, thus centralizing in one department the scientific in-
vestigation of all the hospitals in the yet obscure domains of
mental pathology, and etiology of insantity and correlated fields of
research.
Having thus cursorily outlined the legislation for the insane in
Io8 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 3.
the State of New York since the creation of the Commission in
Lunacy in 1889, it is pertinent to inquire into the results of this
legislation, both as regards the welfare of the insane and the
pecuniary interests of the people. In other words, what improve-
ments, if any, have been made in the general care and treatment
of the insane and in the methods of management and condition
of the hospitals? Also what pecuniary benefits have the people
derived from the substitution of State for county care for their
dependent insane ?
Among the more important improvements as regards methods
and conditions which have accrued to the institutions for the in-
sane and their government, under the new order of things, may
be mentioned the following:
1. A complete registration in the office of the Commission of
all qualified examiners in lunacy ; in the State of New York only
qualified examiners in lunacy may certify to the insanity of a
person for the purpose of commitment. To become an examiner
one must be a reputable and duly licensed physician of at least
three years' standing. These qualifications must be certified to by
a judge of a court of record and the certificate filed in the office
of the Lunacy Commission.
2. A complete registration in the office of the Commission of all
persons committed to institutions for the insane, both public and
private. This registration already embraces about 75,000 cases
of insanity, from which valuable deductions and comparisons may
be made. This information, which heretofore could not be ob-
tained from a single source, nor without great difficulty, is thus
made readily available. The collection of this information has
been greatly facilitated by the adoption of a uniform system of
records and statistical returns for all the hospitals.
3. Provision for the transfer by order of the Commission of
patients from one institution to another without recommitment.
This elastic feature of the State Care Law enables the Commis-
sion to locate patients in hospitals which are most accessible to
their friends ; also to equalize the pressure for accommodations in
the State hospital system.
4. The removal of patients from their homes or elsewhere by
trained attendants sent from the hospitals, women patients, in all
cases, to be accompanied by a w^oman attendant or nurse. Also if
the patient is violent or greatly disturbed, a medical officer from
the hospital accompanies the nurse. The observation of this
rule insures both decency and humanity in bringing patients to the
hospitals. Formerly it was customary for male officers to escort
CARE AND TREATMEInT OF THE INSANE.— Dr. MacDonald.
109
female patients to the hospitals, even though it might be neces-
sary, as was frequently the case, to stop over night en route.
Again such patients were frequently required to travel long dis-
tances in smoking cars set apart for men, grossly improper prac-
tices which, happily, are now a thing of the past.
5. Removal of the legal distinction between acute and chronic
insanity by designating each State institution for the insane as
"hospital" instead of ''asylum," and organizing them all upon a
curative basis, thus inculcating the hospital idea. While it is true
that the State Asylums for the chronic insane, as they were then
designated, served a useful purpose, inasmuch as they afforded
asylum, not hospital, care, for a large number of patients who
otherwise would have been consigned to the poorhouses, there
was a feeling in the community, and especially among the pa-
tients themselves and their friends, that patients sent to the
Willard Asylum were thereafter to be regarded as hopeless and
incurable, and the transfer of patients thereto from the so-called
acute institutions of the State was the occasion of much mental
anguish and suffering on the part of both patients and friends.
Indeed, I have personally witnessed the sorrow and anguish
which patients manifested when marshalled in the wards of the
Utica State Hospital for transfer to the Willard Asylum for the
Chronic Insane. Many of such patients, capable of appreciating
their situation and surroundings, felt when consigned to the
asylum for the chronic insane, that all interest in their welfare,
and especially in their recovery,, was lost. And it is a fact that in
numerous instances when patients were so consigned, their
friends did lose interest in them and ceased to visit them.
Furthermore, the abolition of this distinction has had a most
beneficial effect upon the inmates of the institutions, that formerly
were set apart for the chronic insane, as well as upon the interest
and zeal of their medical officers and nurses.
6. A regulation regarding the correspondence of the insane,
which provides that any patient who desires to do so may write
at least once in two weeks ; letters, for any reason, not forwarded
to destination, must be sent to the office of the Commission for
examination ; letters addressed to the Governor of the State, the
Lunacy Commission, to judges or to any official having jurisdic-
tion in lunacy cases, must be forwarded unopened. This rule is
designed to disarm the criticism that is so often made respecting
alleged suppression of patients' correspondence by hospital offi-
cials, and at the same time to afford patients who regard them-
selves as illegally detained or ill-treated, an opportunity to com-
municate through proper channels with the outside world.
no THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 2.
7. Provision for paroling patients, linder certain conditions, for
a period of thirty days, during which they may be returned to the
hospital without recommitment. This affords opportunity for
testing the fitness of certain patients for final discharge, and to
others for occasional visits at home.
8. A regulation requiring that patients on admission to a hos-
pital shall be informed of the nature of the institution, and the
fact that they are detained under legal commitment.
9. Affording all patients the legal right of a hearing by the
visiting commissioners, apart from any officer of the hospital.
10. A rule restricting the issuing of licenses to conduct private
asylums to reputable physicians of at least five years' experience
in the care and treatment of the insane.
11. The general adoption by the hospitals of a uniform dress
for nurses' and attendants' wear.
12. Provision for the clinical teaching of insanity in the State
hospitals by admitting to the wards thereof, imder proper re-
strictions, students of medical colleges situated in their vicinity,
as well as practising physicians who may desire the opf>ortunity
of studying mental diseases clinically. Under this provision six
medical colleges now avail themselves of the facilities offered by
the hospitals for the clinical teaching of insanity.
13. Provision for the appointment of medical internes in each
of the State hospitals at a salary of $600 per annum, in addition
to the regular medical staff, thus providing a training school for
medical officers, from which the regular medical staff may be
recruited.
14. A regulation requiring competitive civil service examina-
tions for appointment of resident officers in State hospitals. This
provision has resulted in divorcing the hospital service from
partisan influences, and in opening the way for promotion, by
merit, of experienced assistant physicians and other worthy offi-
cers. Only physicians who have had at least five years' experience
in a hospital for the insane are eligible to examination for and
appointment to the position of superintendent. This regulation
has effectually barred the appointment to office of inexperienced
and incompetent physicians through political or other influence,
as was heretofore too frequently the case. It is believed that the
letter and spirit of civil service requirements are more carefully
observed in the State hospitals of New York than in any other
department of the State government, and that under its operation
the hospitals are as free from partisan influences, both in the
matter of appointments and in the tenure of office during efficiency
CARE AND TREATMENT OF THE INSANE.— Dr. MacDonald. Ill
and fitness, as it is possible to have them under a republican form
of government.
15. A material increase in the average rates of salaries and
wages of all grades of service, also an increase in the ratio of
medical officers, nurses, and attendants to patients including a
woman physician, on the staff of each hospital. The schedule of
salaries and wages provides, in nearly all cases, for promotion
in pay at regular intervals, as a matter of right and independently
of favoritism.
16. The introduction of women nurses on the men's wards,
such nurses to be paid the same wages as men.
17. A material extension of accommodation for attendants and
nurses in detached buildings, or nurses' homes, and the employ-
ment of a corps of night nurses, especially in the care of dis-
turbed and untidy patients. This arrangement enables the
nurses, both night and day, when off duty, to retire to their own,
well appointed, quiet apartments where they may obtain needed
. rest and relaxation.
18. The establishment of training schools for nurses in all the
hospitals.
19. Provision for the employment of dentists for patients whose
teeth the medical officers may determine to be in need of atten-
tion, also for ophthalmological examination by eye specialists
with a view to the correction of defects of vision, from which
many patients suffer.
20. An annual allowance to each hospital for the purchase of
medical books and journals, magazines and other periodicals, for
the benefit of the medical staff and others.
21. The employment of a chef in each hospital, in addition to
the ordinary corps of cooks, whose duty it shall be to generally
supervise the cooking in the various kitchens and to instruct the
subordinate cooks and nurses in the preparation of special diet.
2.2. The adoption of a schedule of food supplies, including a
per diem ration allowance of each article. This schedule is de-
signed to serve as a basis for the hospitals in estimating for com-
missary suppHes, and also as a guide for the Commission in its
revision of such estimates.
23. A marked improvement in the methods of bathing, by the
introduction of "rain" or "spray" baths and other hydrotherapy.
24. A requirement that, so far as may be deemed feasible, the
hospitals shall enter into joint contracts for the purchase of staple
articles of supply through competitive bids, the contracts to be
let to the lowest responsible bidders.
112 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. b.
25. The abolition of mechanical restraints in all the hospitals
and the substitution therefor of useful occupations, diversions
and amusements of various kinds. Prior to the enactment of the
State care law the wards of substantially every asylum were
supplied with camisoles, leathern muffs, belts and wristlets, pro-
tection sheets, etc., and many of them also with the *'Utica Crib,"
so called from having first been used in the Utica Asylum. In
addition to these forms of restraint the wards of the Auburn
Criminal Asylum, when I became its superintendent in 1876,
were equipped with an outfit of chains, shackles and hand-cuffs,
many of which were in daily use. At that time, as a result of the
teachings I had imbibed, I believed in the utility of mechanical
restraints and would have regarded a failure to use them in cer-
tain cases as a dereliction of duty, and I so stated in my annual
report for that year. Subsequently, however, on January i, 1879,
after careful study of the subject, I determined to discontinue the
use of mechanical restraints in the institutions absolutely and I
accordingly issued an order therefore to take effect on that date.
This, I believe, was the first instance in the United States of the
absolute abolition of mechanical restraint in a public institution
for the insane. This, at the time, seemed a long step in advance
and one the propriety of which was seriously questioned by sev-
eral of my fellow superintendents. But soon after the step was
taken it was found that the need of these appliances had ceased
to exist, and that under the beneficent influences of amusements,
diversions and useful occupations, together with adornments of the
wards and surroundings of the patients, quiet and order had soon
supplanted the turbulence, confusion and violence which attended
the old methods and which rendered the institution a veritable
bedlam. In the days of restraint it was really dangerous for vis-
itors to pass through certain of the "disturbed" wards of our
public institutions for the insane, whereas, nowadays, visitors to
these institutions not infrequently complain that they have not
been shown the "worst cases," and they ask to see those who are
in "padded cells" or "tied down," and when told that there are no
such cases, or places, in the hospital, they are apt to look incredu-
lous and doubting. So that, even to-day it is difficult for those
who are unfamiliar with the subject to realize that the old condi-
tions have entirely disappeared under modern methods of care
and treatment.
2,6. The introduction in 1901, of tent life for the care of tuber-
culous patients, by the late Dr. A. E. Macdonald, Superintendent
of the Manhattan State Hospital, on Ward's Island, New York
City, marks another important step in the progress of the care
CARE AND TREATMENT OF THE INSANE.— Dr. MacDonald.
113
and treatment of the insane in New York which is worthy of
special mention.
The pronounced success of Dr. Macdonald's experiment of
treating tuberculous insane in canvas tents during the milder
season and which was subsequently extended to all seasons of the
year, has led to the extension, with most beneficial results, of tent
treatment to several other classes of patients, namely, the feeble
and untidy, the convalescents, and finally, to the acute insane,
many of whom, confined to bed and suffering from various con-
current diseases, find in camp life an agreeable and beneficial
change from the more confined surroundings and vitiated air of
the hospital ward. Dr. William Mabon, the present superin-
tendent of this hospital, in a recent paper states that the recovery
rate of cases cared for in the open air is as high as 40 per cent.,
whereas, the death rate is ''extremely low." The experience
of this hospital during the past five years shows that the open
air treatment is especially beneficial to the tuberculous, the feeble
and untidy, the retarded convalescents and the acute insane in
which the psychosis is associated with debility, delirium and in-
somnia."^ Fully equipped camps for both sexes are now main-
tained at this hospital in which large numbers of patients receive
the same general routine treatment that is given to indoor cases
with the added benefit incident to life in the open air. This
system of outdoor treatment of the insane is gradually being
adopted by other hospitals, both in New York and in other States.
27. The systematic employment of patients at useful occupa-
tions, such as farm and garden work, in the various repair shops,
bakeries, kitchens, laundries, tailor shops, sewing rooms, stables,
etQ. Also at various industrial occupations, such as the manufac-
ture of clothing and foot wear, furniture, brooms and brushes
of all kinds, hair mattresses, rugs, upholstering, chair caning,
bookbinding, printing, etc., etc. The finished products of these
industries are not sold in open market, but are disposed of at
actual cost to other hospitals which may not manufacture or pro-
duce the particular article, thus avoiding direct competition with
trades unions. For instance, one hospital roasts all the coffee, or
manufactures all the brushes, or supplies all the printed blank
forms that may be required by the other hospitals.
* Those who may desire detailed information respecting the methods
and results of tent treatment of the insane in New York are referred to
the annual printed reports of Manhattan State Hospital (1901 to 1906) ;
also to a paper on Tent Treatment for Tuberculous Insane (illustrated)
by A. E. Macdonald, M.D., reprinted from A Directory of Institutions
and Societies Dealing with Tuberculosis in the United States and Canada,
1904; also Open Air Psychiatry by Dr. William Mabon, N. Y. Medical
Journal, February 9, 1907.
114 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 3.
28. The establishment of a Pathological Institute: Criticism
having been made from time to time by eminent members of the
medical profession, of the indifference and inattention of the hos-
pitals for the insane generally throughout the United States to
scientific investigation, the Lunacy Commission, after first secur-
ing the material welfare of the insane, as regards their proper
housing and care, proceeded to establish a department of sci-
entific investigation of mental diseases. This centre of scientific
investigation in insanity and allied fields of research was desig-
nated the Pathological Institute of the State Hospitals, to indicate
the preponderance, but not the exclusive application, of the study
of pathology to problems of insanity. The plan in establishing
the pathological institute was practically not to restrict its studies
along any one exclusive line of science, but to make such investi-
gation broad and comprehensive by the union of all those branches
of science which can be practically brought to bear upon the
scientific study of mental disease. The great renaissance in our.
knowledge of the normal nervous system accomplished by the
method of Golgi and his followers, the great progress in the
science of the cell structure, the progress of bacteriology, linked
with physiological chemistry, the comprehension of the corre-
lation of the nervous system with other portions of the body,
the tendency to correlate all of these sciences so that they might
be focussed upon the problems of the physical basis of insanity,
made the time ripe for establishing a central department for the
scientific work of the State Hospitals, not as an experiment, but
on a permanent basis, and one which would justify the expendi-
ture of the considerable moneys which such an undertaking to be
successful, necessarily requires. As already intimated, such a
conception of investigating the nervous system as a dependent
part of the body in the broad light of the operation of the general
laws of pathological processes and by co-ordinating pathological
histology with its sister sciences was a distinct departure from
the plans of working at these problems in the past.
Furthermore, it was deemed wise, both from an economical and
a scientific standpoint, to centralize the research work of the hos-
pitals in a single institution, in order that unity of method in in-
vestigations might prevail and proper guidance and systematizing
of the work by a master hand might be in order.
In its eighth annual report to the Legislature (1897) the Com-
mission, referring to the Institute said : —
"The future progress of work of this kind, then, may be be-
lieved to justify much expectation in the investigation of the most
CARE AND TREATMENT OF THE INSANE.— Dr. MacDonald. 115
subtle and difficult field of the causation of disease, namely, the
morbid condition of the nervous system, which gives rise to and
underlies the manifestations of insanity, and it is believed the
people of the State will not fail to sanction the making of neces-
sary expenditure for carrying on this most important work for
which the time has only so recently been adequate. It is not too
much to hope that in the comparatively near future such investi-
gations will exhibit practical results both in the prevention and
cure of insanity."
The Institute is divided into departments and the gentlemen
in charge of these departments are designated associates in their
respective branches, the whole being under a Director, distin-
guished for his scientific attainments. Dr. Adolf Meyer.
29. A codification of the laws of the State relative to the insane
into one comprehensive statute, known as the "Insanity Law,"
thus bringing the hospitals into unison, under one charter, and
placing them all on an equal footing in the matter of organization,
administration and finances.
Respecting what has been accomplished in the direction of im-
provements to the hospitals, as well as in the promotion of the
welfare and comfort of their inmates, as a direct result of the
adoption of the policy of State care, a perusal of the annual re-
ports of these institutions would show that their condition as
regards structural improvements and equipments, sanitary condi-
tion, order and cleanliness, fire protection, furniture, clothing,
food supplies, industrial and other occupations, means of diversion
and amusements, discipline, nursing, medical service and organi-
zation, has been steadily progressive and that the standard of
care is in all respects much higher than it was prior to the enact-
ment of the State Care Law, while at the same time the cost of
maintaining the hospitals has been greatly diminshed. Prior to
October i, 1893, at which time the Commission was given super-
vision and control of the hospital finances, the average annual per
capita cost for maintenance was $222. The Commission reduced
this to $184, at the same time materially raising the standard of
care, thus effecting, in a single year, a saving of hundreds of thou-
sands of dollars.
It is the will of the people of the State of New York, that its
hospital system shall be conducted on a plan that will afford
every opportunity of recovery to recoverable cases and at the
same time insure proper care and treatment to the chronic insane,
to the end that their condition may be improved as far as possible
and that the most hopeless of these unfortunates may have the
Il6 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 3.
chance of possible recovery, under the best conditions and en-
vironments with which they can be surrounded. In other words,
the people of this great commonwealth desire that in their stan-
dard of care and in their results their hospitals for the insane
shall stand second to none in the world, and I believe they are
abundantly able and willing to supply the necessary means to
secure these conditions and results.
The progress and present status of the New York State hos-
pital system, which I have endeavored to portray, may be re-
garded as a continuation, if not the full fruition, of the great
reform movement in behalf of the insane, inaugurated more than
a century ago, by Pinel in France, by Tuke in England, by Jacobi
in Germany and by Rush in the United States.
This splendid system, begun in 1836 and consummated in 1890,
representing a growth of more than half a century, is a living
monument to unselfish effort for humanity and science. Its
existence to-day marks a great and lasting triumph of phil-
anthropy and humanity over ignorance and greed, in the march
of civilization.
All honor to the Medical Society of the State of New York,
which, through its humane secretary, Dr. Willard, blazed the
pathway of this great reform through a wilderness of ignorance
and greed. All honor to those good men and women who later
renewed the struggle, against fearful odds, and courageously bore
the burden of conflict for the emancipation of these mentally
afflicted fellow-beings to a successful issue. They may well be
pardoned feeling an exultation and a sense of triumph.
It is not claimed that the new system is, unlike other human
agencies, without imperfections. It is claimed, however, that
its already demonstrable advantages over the system which it
superseded are so great as to convince even the most sceptical
of its former opponents of its superiority, both in its humane
and its financial aspects; also that the principle of State care
founded on the broad basis of science and humanity, when intel-
ligently applied, as it is in the State of New York to-day, stands
for all that is best in our present knowledge of the care and treat-
ment of the insane.
A NEW METHOD OF PRESERVING THE CEN
TRAL NERVOUS SYSTEM FOR
MORPHOLOGIC STUDY.
By Professor A. Giannelli,
Director, Anatomo-Pathological Laboratory,
{From the Hospital for the Insane, Rome, Italy, Dir. Prof, G.
Mingazzini. )
The methods used for preserving the central nervous system in
toto are unsatisfactory for the purpose of morphologic study of
the brain, the defect being especially noticeable w^hen one wishes
to study the cerebral convolutions. The solutions in general use
harden the brain substance after a short time, and this makes it
difficult to handle and tO' follov^ out the course of the convolutions
— in their normal or abnormal curves and the plicae internas. To-
day it is quite important to be enabled to follov^ out the course of
the convolutions ; especially so since S. Sergi has pointed out the
existence of internal accessory iissures that are seen on the
anterior surface of the posterior central convolution in the Hylo-
bates Syndactilus ; similar fissures were afterward found by
me in many brains of the insane. I then undertook the task of
finding a fluid that would preserve the cerebral substance without
hardening it. Chloral hydrate has long since been used in micro-
scopic technique: by Moeller — in botany; by Overton, Zimmer-
mann, Schimper Lenze and others ; Rolles Lee and Henneguy
especially recommend chloral in solutions of from 2 per cent, to 5
per cent, for macerating substances for study. Lewandowsky
used chloral solutions for the study of the salivary glands, and
Hickson for the study of the retina of the arthropodous. loetin-
ger, Verworon and Kueckenthal found chloral hydrate as an ex-
1 18 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 3.
cellent fixative in the study of the bryozoa, the Mullusca and the
annulose; chloral hydrate has been used with Hoyer's and Kult-
schitzky's carmine solutions, with VanWijke's ammonia-picro-
carmine and Gage's hematoxylin, etc.
Butzke has used aqueous solutions of chloral hydrate (i:i to
I :io) for the study of the nervous cells of the central nervous
system. And I have been enabled to convince myself of the cor-
rectness of his claim that a combination of chloral and hyper-
osmic acid (34 per cent.) is excellent for isolating the cellular
elements.
I do not find, however, that chloral hydrate has been used for
the purpose I indicate in this paper. My method is as follows : as
soon as the brain is taken out of the cranium it is stripped of the
meninges and preferably cut into its two hemispheres along the
interhemispheric fissure; it is then put into an aqueous solution
of chloral hydrate of from lo per cent, to 15 per cent. This solu-
tion is changed six hours later, then twenty- four hours later;
then again twenty-four hours later ; then it may be changed twice
every three days, and then every eight days until the solution
remains absolutely clear and transparent. In order to obtain the
proper consistency of the braini substance it is necessary to change
the fluid as soon as it becomes cloudy.
The chloral solution renders the brain substance bloodless;
hence the solution is deep red and rose colored after the first six
and the first twenty-four hours; if the fluid is not changed, the
brain becomes rose colored.
The brain substance thus treated is well preserved while re-
taining the consistency it had at the time of the autopsy. The
convolutions may be pulled apart without tearing them; they
present neither increase nor decrease of volume ; their surface
presents all the particulars seen at the time of the autopsy and the
convolutions retain their normal reciprocal positions. The insula
can thus be examined in its normal position — ^by pushing aside its
limiting convolutions. The study of the calcarine fissure is also
made convenient (Zuckerkandl) without necessitating the cutting
away of parts of the neighboring convolutions. The cerebellar
hemispheres also retain their normal form : not only is it possible
to handle the individual cerebellar convolutions, but also the
single layers accompanying each lobe can be studied with ac-
curacy.
When properly treated with chloral hydrate the spinal cord
presents facilities for the study of the anterior and posterior
horns and their relation with the ganglia.
For the study of the brain I cut it preferaibly into its two hemi-
PRESERVING THE CENTRAL NERVOUS SYSTEM.— Giannelli.
119
Spheres before plunging it into the chloral solution ; this facilitates
the contact of the inner surface of each hemisphere and of the
ventricles with the solution, and the convolutions in this region
become of proper consistency for study.
In order to obtain good results the following conditions are
necessary :
1. Each cerebral hemisphere should be plunged into not less
than two litres of a 10 per cent, solution of chloral hydrate.
2. The pia mater should be torn off before the hemispheres are
put into the fluid — or immediately afterward. This operation
requires patience and is easiest executed by tearing off the mem-
brane while the brain is in the solution. To avoid abrasions of
the brain substance, the pia mater should be torn off not later
than after the first two hours following the autopsy.
3. To avoid artificial deformation of the brain surface absorb-
ent cotton should be put at the bottom of the vessel destined to
hold the brain.
4. The fluid should be changed after the first six hours, then
after the first twenty-four hours — twice in succession; then —
after three days — twice, and finally after every eight days.
As a general rule, the fluid should be changed as soon as it
becomes cloudy. In my experience the fluid becomes clear after it
has been changed some eight or ten times.
If it is desired to give the brain some firm consistency for the
purpose of morphologic study of the convolutions and sulci it
can be done by adding to the chloral solution used for the first few
times a few cubic centimeters of a 10 per cent, solution of formol.
Any desired consistency of the brain may be obtained by succes-
sive addition of a few c.c. of formol solution to the chloral solu-
tion when the latter is changed.
The following is a good formula for the solution to be used
for one hemisphere:
Chloral hydrate 200 grams
Distilled water 2 litres
Formol (10 per cent, sol.) 100 cubic centimeters.
This solution should be changed as indicated above. After
twenty days I have used a 10 per cent, solution of chloral without
formol.
I have specimens of brains obtained six months ago and treated
with this method that present a normal consistency. I have ob-
tained the same results with this method — regardless of the time
of the year or the temperature in the room when it was used. I
have specimens of brains taken from adult rabbits that present
120 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. S.
the same freshness of consistency as they did on the day of the
autopsy.
1 have tried to determine whether the brain weight underwent
any change after the organ had been treated for thirty days with
a lo per cent. sol. of chloral hydrate. I did not study this ques-
tion as regards longer periods because this time suffices for all
purposes of morphologic study.
The brain increases in weight from 6 per cent, to 7 per cent,
after thirty days' treatment with a 10 per cent, solution of chlora!
—changed as indicated above. This is a greater increase in
weight than is obtained when treated with a 10 per cent, solution
of formol during the same period, the latter solutions causing
only a 3 per cent, increase in weight, as is indicated by Flatou.
When treated with a bichromate solution (2.5 per cent.) the in-
crease of weight is 32 per cent. (Donaldson). The brain weight
decreases when treated with alcohol (30 per cent, decrease of
weight after thirty days' treatment with alcohol at 96 degrees).
The chloral method of preserving brains also has the advantage
of being free from evaporations that are irritating to those who
handle the specimens, as is the case with the alcohol and formol
method; chloral is also convenient because it does not stain the
hands and objects that come in contact with it — as is the case
with bichromate and formol solutions. Another advantage is that
after subjection to this method the brain may be treated with any
other method. The brain thus treated is also convenient for
class demonstration. ■ .
Rome, Italy, October i, 1907.
References.
BoLLES Lee and Henneguy. Traite des methodes techniques de I'anato-
mie microscopique, 2d edition. Paris, 1906.
V. BuTZKE. Studien ueber den feineren Bau der Grosshirnrinde, Arch,
f. Psych., Bd. Ill, S. 575, 1872.
Donaldson. Preliminary observations on some changes caused in the
nervous tissues by reagents commonly employed to harden them, Jour, of
Morphol., Vol. IX, 1894, Boston.
Ehrlich. Encyklopedie der mikroskopischen Technik, 1903. Urban
and Schwarzenberg, Berlin, Wien.
Flatau. Veraenderungen des Hirngewichts in Formolloesung, Anat.
Am., 1^7.
PERIPHERAL AMYOTROPHY DUE TO NERVE
TRAUMATISM. CLINICAL AND ANATO-
MOPATHOLOGIC STUDY.
By Dr. R. Bonfigli^ Senior Physician, Manicomio, Rome, Italy,
(From the Anatomo pathologic Laboratory, Dir. Prof. A. Gian-
nelli, Rome, Italy.)
The genesis of muscular atrophy following traumatism of
peripheral nerves is as yet not well known. Toward the end of
the XVIIIth century the cause of muscular atrophy was attrib-
uted to ascending neuritis, but to-day this view is not accepted ;
the etiology seems rather complicated from the clinical and an-
atompathologic study of the disease.
The case below cited is one of amyatrophy following trauma-
tism to a peripheral nerve. The anatomopathology of the case
is also given.
The patient, P. R. E., a woman, 45 years old, was admitted to
the Hospital for the Insane, Rome, Italy, October 24, 1905. Her
first admission to the hospital was December 13, 1878. Her
disease was then diagnosed as mania, and she was discharged
as cured three years later. Her parents are illiterate and she is
in a stupid condition, so that her history cannot be had in detail.
A few years before her second admission to the hospital she re-
ceived a blow on the left shin bone. It is not quite clear whether
122 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 3.
the traumatism was inflicted with a stick or whether she had been
bitten by a dog. The patient states that the wounds suppurated,
and cicatrices remain as traces of the traumatism. A few months
before her last admission to the hospital she suddenly became vio-
lent, refused to eat, walked out naked into the street and assaulted
those who tried to interfere with her.
Objective Examination. — The skull is normal and has the
following diameters: antero-posterior — i8o centimeters; trans-
verse— 145 cts. ; longitudinal curve — 315 cts. ; transverse curve —
285 cts.; maximum horizontal circumference — 530 cts.; anterior
hemicircumference — 285 cts.
Bony frame well developed, but the patient is emaciated. Mur-
mur at the cardiac apex, replacing in part the first sound and con-
tinuing after it. Muscles flabby. The lower left limb is reduced
in volume as compared with the right one ; measured at the middle
line, the left leg has a circumference of 183 millimeters, while the
corresponding circumference of the right leg is 212 millimetres.
The circumference of the middle of the left thigh is 240 mm. ;
that of the right one — 270 mm. The muscular atrophy of the left
thigh is uniform.
Impossible to examine the sensibility because the patient is ex-
cited. There are no signs of focal lesions. The pupils react to
light; knee reflexes good; plantar and pharyngeal reflexes good;
the sensory organs seem to be normal.
Psychic state. — Attention is now normal, now distracted, the
rapid change seeming to be caused by sensory disturbances and
hallucinations ; memory of time good, but inaccuracies are due to
delusions and hallucinations. The patient is in a condition of con-
tinuous motion, now rhythmic, now automatic; delusions and
hallucinations seem to be of mystic nature: devils try to insult
her and enter her body; in defense — she makes the sign of the
cross all over her body and strikes those who approach her. At
other times she sees saints and angels who protect her and she
holds out her hands to them, apparently in prayer.
This condition of agitation continued for two months, during
which the patient became emaciated and exhausted. She died
January i, 1906.
Autopsy. — 24 hours after death. Cranial bones of normal
thickness. Dura mater adherent to the calvarium; pia mater —
vessels injected, edematous, glistening, easily detached from con-
volutions. Basal ganglia and medulla oblongata of normal as-
pect; spinal meninges considerably thickened; white and gray
cerebral substance and nerves of normal aspect. Thoracic and
PERIPHERAL AMYOTROPHY.— Da. Bonfigli. 123
abdominal organs normal. Muscles of the atrophied limb some-
what paler than the others.
Spinal cord put into alcohol — 96 degrees and into Mueller's
fluid for examination of the cells and nervous fibres. The cells
of the spinal cord were studied with Nissl's method and toluidin
blue ; and the nervous fibres — with the Kulschitzky-Wolters stain ;
the muscles — were treated with the van Gieson-Weigert method.
Pathologic Anatomy. — Spinal cord-cervical region : under
low power (objective 4, ocular 4) : pia mater considerably thick-
ened and the injected vessels present an obstructed lumen. Large
connective tissue bands run from the pia mater into the white
matter along tortuous blood-vessels. The white and gray matter
present no alterations. Under high power (objective — homogene-
ous immersion — 1/15, ocular — 4) : the pia mater and the connec-
tive tissue bands springing therefrom are rich in small round or
oval cells, deeply stained, granular in appearance, some being
more deeply stained than the rest. Many such cells are seen
around or within the vascular walls. Most probably these cells
are leucocytes.
The endothelial and muscle cells of the thickened vascular walls
are numerous; the vascular lumen is narrowed and filled with
blood corpuscles among which are seen numerous mono- and
polynuclear leucocytes. In some places the clots are made up
entirely of leucocytes. The vessels are tortuous and the peri-
vascular spaces are large. The glia seems to be normal and its
nuclei do not seem to be increased in number or volume.
The groups of nervous cells in the gray matter seem to be
normal on both sides ; the cells of the anterior horns are perhaps
smaller than normal, but their nuclei are round, well defined,
colorless and the nucleoli are also well defined; the Nissl bodies
are w^ell stained and the prolongations are long and straight.
The fusiform cells of the posterior horns, those of the gela-
tinous substance of Rolando and the columns of Clarke seem to
be normal. Similar conditions are presented in the dorsal region.
In the lumbar region the alterations are more characteristic;
under low power: there is a marked difference between the cells
of the right and left anterior horns : on the right side the cells
are normal in structure and number, while on the left side they
are markedly decreased in size and are rarified. The pia mater
is thickened, rich in blood vessels and large bands of connective
tissue part from it and reach into the white matter. Under high
power: leucocyte infiltration around the vessels, that are filled
with blood clots and their walls are thickened. Numerous pig-
ment granulations are seen within the vascular walls and in the
124 ^^^^ JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 3.
surrounding connective tissue. The vessels do not seem to be
altered in the white and gray matter, except that their walls are
somewhat thickened and some of the vessels are filled with blood ;
but around them there is no lymphocyte infiltration or pigment
granulation to any extent. The most marked alterations in this
region are those of the nervous cells of the anterior horn. On the
right side the cells are normal (see fig. No. i). They are large,
with a large, colorless, well defined nucleous, the nucleolus being
placed in the middle and deeply stained ; the Nissl bodies are well
defined and deeply stained about the nucleus, and paler at the
periphery. The prolongations are long and straight. These
cells appear in well defined groups, occupying mostly the antero-
external region of the anterior horn. On the left side the cells
of the anterior horn are markedly altered (see fig. No. 2). They
are considerably reduced in volume ; their nucleus is not well de-
fined, slightly stained, the Nissl bodies are ill defined and ill
grouped, most of them appearing as a finely granulated amor-
phous substance. Some of the cells are less markedly altered, but
their volume is subnormal as compared with those on the right
side. The greatest alterations are found in the middle latero-
ventral and latero-dorsal groups of cells of the anterior horn.
In Clarke's column the cells are only slightly altered, if at all ;
those of the posterior horn do not show any alteration. The glia
appears slightly increased, especially in the peripheral part of the
cord; its nuclei are numerous.
Transverse and longitudinal sections of the musqles show
marked proliferations of the sarcolema nuclei; the fibres are
wasted, transparent and divided one from the other by connective
tissue bands; and the tracts of muscular fibres are also sur-
rounded by bands of connective tissue rich in vessels that are
slightly altered. The transverse and longitudinal structure of
the fibres are normal.
The peripheral nerves that had sustained the traumatism present
marked thickening of the perineurium but no other alterations.
The Other peripheral nerves are normal.
Summary. — The peripheral traumatic wounds of the lower left
limb were followed by infection and suppuration that had finally
healed. Uniform muscular atrophy involving equally all the mus-
cles of this limb followed the suppuration. The circumference
of the left thigh and leg was reduced three centimetres as com-
pared with that of the right side. The atrophy was exception-
ally severe; according to Sicard (i), the evolution of ascending
traumatic neuritis is not necessarily progressive and is arrested
in its course in most cases ; but only severe traumatisms are fol-
TilE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No, 8.
''^'*«i--
r^. /^
0 « e
/
FIG. I.
* ^
/^^>''
PERIPHERAL AMYOTROPHY.— Dr. Bonfigli. 125
lowed by ascending degeneration (2). Another fact worthy of
note in my case is the exaggeration of the reflexes. In most cases
of this kind the tendon reflexes remain normal, but sometimes
they are exaggerated and rarely abolished (3).
In Angiolella's case there was exaggeration of the reflexes of
the lower limb. The author explains this by the probability of
interfered cerebral inhibitory action or else — exaggerated excita-
bility of the spinal cells (4).
The autopsy showed traces of meningeal inflammation and the
microscopic findings showed similar alterations. The pia mater
was thickened, rich in blood vessels filled with clots of red and
white blood corpuscles ; this points to a progressive inflammatory
process. This process of meningeal irritation, which according to
Pierre Marie and Leri (5) suflices to explain the frequent de-
generation of the posterior columns in cases of muscular atrophy
caused by traumatism of the peripheral nerves, may be explained
by an ascending course of the infection along the nerves in-
volved; this mechanism explains the alteration of the spinal
ganglia consequent to involvement of the peripheral nerves, while
the nerves sustaining the traumatism are rarely altered them-
selves.
According to Pierre Marie and Leri, muscular atrophy of the
regions not supplied by the injured nerves is caused by degenera-
tion of the spinal ganglia cells of the anterior horns — subsequent
to a diffuse meningeal process. Esposito has pointed on the mi-
gratory tendency of traumatic atrophy and he considers this mi-
gratory tendency as a pathognomonic sign of traumatic amyo-
trophy. But this atrophy should not be ascribed exclusively to a
diffuse meningeal inflammation. Among other pathogenic factors
mentioned are: reaction a distance, retrograde degeneration of
'Durante, indirect Wallerian degeneration of vanGehuchten, peri-
neural processes due to local infection of the wound, sympathetic
action of the spinal cellular groups, etc. ; finally, tertial atrophy of
the collateral fibres of the long and short tracts of Mingazzini
has been pointed out as a cause of post-traumatic amyotrophy (6).
The most marked microscopic alterations found in my case
were in the pia mater and the cellular groups of the lumbar region
of the spinal cord on the side where the traumatism had been
inflicted ; in the cervical region of the cord the lesions were on
both sides. These conditions point to the facility with which an
infectious process may extend from the periphery of a nerve
into the depth of the spinal cord, while the nerve itself is not
deeply affected : in my case the central nervous branch involved
in the traumatism presented only slight alterations while the
126 iHE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 3.
destructive process in the corresponding ganglia was marked.
This fact demonstrates once more that post-traumatic amyotrophy
of combined nature, as pointed out by Esposito, has for its cause
besides the ascending degeneration of the wounded nerve, —
Duchenne's sympathetic degeneration of the spinal groups of cells
and, to the greatest extent, — the inflammatory process of the
spinal meninges consecutive to the peripheral nerve traumatism.
RoME_, June, 1907.
References.
1. Sicard R. Le syndrome de la nevrite ascendante. Archives
de Neurologic J p. 190, 1905.
2. Remak. Neuritis u. Polyneuritis^ Nothnagel, S. 201.
3. Esposito. Amiotrofie da trauma nervoso periferico. Studio
clinicOj Manicomio inter provincialCj Vol. E, II, in Nocera Inf.,
1906.
4. Angiolella G. Contributo alio studio delle nevriti ascendenti,
Manicomio interprovinciale, Vol. E, II, in Nocera Inf., 1906.
5. P. Marie and Leri. Discussion of R. Sicard's communica-
tion, meeting of French alienists and neurologists, August, 1905,
Archives de neurologic, p. 190, 1905.
6. Esposito, I.e.
A CASE OF KORSAKOFF'S PSYCHOSIS DUE
TO AN UNUSUAL CAUSE.
By Dr. Serge Soukhanoff^ Privat-Docent, University of
Moscow,
The patient (*), S. V. M., a woman, 21 years of age, has been
married 8 months. Last menstruation — latter end of September,
1905. Since October 14 of that year — frequent vomiting difficult
to control, coinciding with a beginning pregnancy. The vomiting
exhausted the patient, and she was taken to a private hospital for
treatment, where she soon improved. She remained in bed on
account of physical weakness and a febrile condition, her tempera-
ture rising to from 37.1 to 37.7; her pulse ranged from 100 to
120 per minute — out of proportion to the temperature. Toward
the end of December her lower limbs became weak so that she
* I saw the patient in consultation with Dr. F. A. Alexandroff.
KORSAKOFF'S PSYCHOSIS.— Dr. Soukhanoff. 127
could not support the weight of her body. In the beginning of
January she showed mental disturbance for the first time and
impairment of her memory was most noticeable. She recognized
those about her, but often remarked that she had seen people
whom in reality she could not have seen in the hospital. The
knee reflexes disappeared soon after her mental disturbance had
been noticed and pressure on the nerves of the limbs was painful.
At one time she saw objects double.
She remained in bed in a weak condition; muscular action of
the hands weak and marked by slight incoordination ; contracture
of the left leg that remains flexed at the knee joint ; marked pain
when attempt is made to straighten this limb; the right leg is
held in extension and the patient cannot lift it up. Absence of the
knee reflexes. The muscles of the calf of the leg are wasted,
flabby and weak; the muscles of the pelvis are also flabby; those
of the upper extremities are affected to a lesser extent. Speech
somewhat impaired; function of the facial muscles — somewhat
impaired; the slightest pressure on the muscles of the lower ex-
tremities on both sides causes the patient to cry out with pain.
No particular pain on pressure of the upper extremities. The
pain in the muscles makes it impossible to investigate the reaction
to pain of the sciatic nerve.
The patient is talkative and childish and often asks at random
for more food. She often remarks that there is ** Something
wrong in her head" and complains of weakness in her legs ; mem-
ory impaired as regards events since the onset of her illness;
recalls with difficulty the name of the present month or the name
of the month when she became ill. When asked whom she has
seen to-day, she assures me having seen persons whom she could
not possibly have seen; she tells a story of having met me before,
when in reality this is the first time she has seen me. When cor-
rected on this score, she does not feel offended and agrees with
me that she is making a mistake. Conversation fatigues her.
Her pulse is 120 per minute, but this does not affect her good
humor.
This case is undoubtedly one of Korsakoff's psychosis. Signs
of polyneuritis are marked ; there is absence of the knee reflexes :
muscular pain on pressure ; marked weakness of the legs that is
almost paralytic; impaired muscular strength in the upper ex-
tremities; rapid pulse (affection of the pneumogastric nerve), etc.
Alongside with these disturbances the patient presents peculiar
psychic disturbances: she is good-natured, her memory is im-
paired as regards recent events and she imagines having seen
people many times, whom in reality she could not have seen.
128 THE JOURNAL OF MENTAL PATHOLOGY. Vol. Vm., No. 3.
These physical and psychic signs are expressive of Korsakoff's
psychosis.
The conditions in which this case of Korsakoff's psychosis de-
veloped are interesting: persistent vomiting set in early in her
pregnancy; Korsakoff's psychosis is also generally characterized
by vomiting early in the disease. But in this case it is difficult to
specify exactly at what time Korsakoff's psychosis set in. Per-
sistent vomiting is considered by some as being due to autoin-
toxication; Korsakoff's psychosis is also an expression of auto-
intoxication. It is difficult to say whether or not the psychic
trouble in this case was the result of autointoxication with poly-
neuritis and whether or not the severe form of vomiting resulted
from another infection. I am inclined to think that Korsakoff's
psychosis and the vomiting had each its particular form of auto-
intoxication. The rise of the subfebrile temperature to '^'j.'j de-
grees C. points to some form of autointoxication. But alongside
with this condition, the urine contained albumen, sugar and hy-
aline casts — which points to renal infection; and which together
with the other unfavorable organic conditions caused the onset
of Korsakoff's psychosis. Gynecologic examination was negative
as regards the genital organs.
The question presents itself whether or not there is an analogy
between Korsakoff's psychosis caused by hepatic trouble (jaun-
dice) and the psychosis here described — due to renal trouble. In
this case it is difficult to see the exact nature of the psychosis
because the patient's general exhaustion was due to the severe
vomiting; although the renal trouble must have been the main
cause of the autointoxication that brought on Korsakoff's
psychosis; the other factors in the autointoxication due to the
pregnancy should not be excluded from the causation of the
disease.
Among the many signs of the disease in this case may be men-
tioned retinal hemorrhages in both eyes, which must have taken
place during the onset of Korsakoff's psychosis — when the pulse
was already rapid. These hemorrhages point to alteration of the
muscular walls that is probably due to autointoxication. As is
known, cerebral hemorrhages of various forms are frequent dur-
ing the course of Korsakoff's psychosis. It is probable, there-
fore, that the retinal hemorrhage in this case was simply one of
the symptoms of cerebral hemorrhage that often precede Korsa-
koff's psychosis.
METHODS OF RESUSCITATING ELECTROCU
TED ANIMALS. DIFFERENT EFFECTS OF
VARIOUS ELECTRIC CURRENTS AC-
CORDING TO THE METHOD USED.
IMPORTANCE OF EXCLUDING
FROM THE CIRCUIT THE
CENTRAL NERVOUS SYS-
TEM DURING RESUS-
CITATION.*
SECOND PRELIMINARY COMMUNICATION.
By Louise G. Robinovitch, B. es L., M.D.^ Paris, Member,
Nezv York Academy of Medicine; Member, American
Medical Association ; Foreign Associate Member,
Medico-Psychological Society, Paris.
The researches presented in this communication were made
according to two distinct methods. In the old method of resus-
citation the cathode was fixed at the head during the rhythmic
excitations. In the new method I exclude the head from the
electric circuit, by shifting the cathode to the back of the chest.
In my first preliminary communication, entitled, "Resuscitation
of Electrocuted Animals. Choice of the Electric Current and
Method Used. Application to Human Beings. Experimental
* Abstract and tracings of the blood pressure and respiration presented
at the Congress of French Alienists and Neurologists, held at Geneva,
Switzerland, August 1-7, 1907.
Abstract, tracings of the blood pressure and respiration and part of
the experiment presented at the International Congress of Psychiatry,
Neurology and Psychology, held at Amsterdam, Holland, September 2-7,
1907.
Abstract and tracings of the blood pressure and respiration presented
at the International Congress of Hygiene and Demography, held at Ber-
lin, Germany, September 23-29, 1907.
Part of the experiment presented by invitation at the Moabit Kranken-
haus and at the Rudolf Virchow Krankenhaus, September-October, 1907.
Tracings of the blood pressure and respiration also presented.
130 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 3.
Study of the Respiration and Blood Pressure during Electrocu-
tion and Resuscitation," published in The Journal of Mental
Pathology, Vol. VIIL, No. 2, 1907, I stated that the effects
obtained in my experiments with the induction current for the
purpose of resuscitating electrocuted animals — according to the
old method indicated in that paper — did not warrant the use of
this current; that a current of low tension and moderate inter-
ruptions was preferable for this purpose. In my experiments
that followed I have tried to study three particular points re-
garding the method of resuscitating electrocuted animals; this
study may be grouped under three different headings as follows
below:
I. — The comparative value of the electric current chosen for
the purpose of resuscitation.
II. — The comparative effects of various electric currents when
used on dogs and on other animals respectively.
III. — The value of exclusion of the animal's head from the
circuit when practicing the rhythmic excitations for the purpose
of resuscitation.
I. — Comparative Value of the Electric Current Used in
Relation to the Old Technique Employed in My Experi-
ments. The old technique used in my experiments is described in
my Paris thesis "Sommeil electrique, epilepsie electrique and
electrocution," as well as in my paper cited above : the cathode is
fixed at the head and the anode at the lower end of the spine. The
experiment is performed on a rabbit; the animal is subjected to
an electric current of 14 volts (current of low tension and moder-
ate interruptions) during a period of from 30 seconds to two
minutes — until the blood pressure in the carotid artery and the
respiration are no longer registered, and the animal is in a con-
dition of apparent death. I stated that it was possible to resusci-
tate a rabbit in this condition by means of rhythmic excitations
with the same current that had caused death — the electrodes re-
maining in their original positions.
The rhythmic excitations are produced by means of a small
mercury interrupter during one second and at intervals of from
two to three seconds — according to the gravity of the electric
shock and especially according to the energy of respiratory reac-
tion of the animal.
It is comparatively easy to resuscitate a rabbit electrocuted
with the Leduc current — by using rhythmic excitations of the
same current. But resuscitation is quite difficult or impossible
when the animal is electrocuted with a continuous or an induc-
tion current.
RESUSCITATING ELECTROCUTED ANIMALS.— Robinovitch. 131
The results obtained from the use of the various currents are
formulated below.
1. The effect of the Leduc current in a lethal potential is far
less dangerous to the respiratory and cardiac centres than is that
of the continuous or of the induction current.
2. In a series of electrocutions caused by the continuous cur-
rent, passing through the body during a period of one minute,
more or less, I did not succeed in resuscitating the animals by
means of rhythmic excitations caused by the same potential of the
same current. And the few exceptional animals that were thus
resuscitated died a few hours after the experiment.
3. The continuous current of lethal potential paralyzes the
heart definitely and should not be used for rhythmic excitations
for the purpose of resuscitating animals electrocuted with the
same current.
4. The induction current of lethal potential, when passing
through an animal's body from thirty seconds to one minute is
also a cardiac paralyzer. In a series of electrocutions caused with
this current (for a rabbit-Dubois-Raymond's apparatus running
on 8 volts of accumulators, coil No. 2, placed at 5.5 centimeters
of the scale) I did not succeed in resuscitating animals by means
of rhythmic excitations with the lethal current. And the excep-
tional animals that were thus resuscitated died a few hours after
the experiment.
5. The induction current seems to kill the animal by paralysis
of the respiratory centers— in the first place — if one is to judge
the matter by the respiratory tracings and the blood pressure in
the carotid artery (some of these tracings are published in my
papers cited above, and the others I present to you for inspec-
tion) ; cardiac paralysis follows rapidly.
6. During the passage of the lethal induction current the res-
piratory muscles seem to be particularly affected by tetanic con-
vulsions; these muscular convulsions are so marked that the
registering drum makes a noise that is heard at a distance.
7. As I found it difficult to resuscitate animals electrocuted
with a continuous or with an induction current, by applying
rhythmic excitations of the corresponding currents, I tried to
resuscitate the animals electrocuted with these currents by using
the Leduc current for the rhythmic excitations.
8. Using the Leduc current for the rhythmic excitations, I
succeeded in many cases to resuscitate animals electrocuted with
the direct or the induction current.
9. It is self-evident that when the heart and respiratory cen-
tres are definitely paralyzed with the lethal currents used, even
132 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIH., No. 3.
the preferred current will not resuscitate an electrocuted animal.
But when an animal is brought into a condition of apparent death
by means of the continuous or the induction current, and there
remains the slightest chance of resuscitation, the latter may be
accomplished by practicing rhythmic excitations with the Leduc
current; similar excitations practiced either with the indtiction or
the continuous current will only help to kill the animal, as may be
judged from the tracings which I have the honor of presenting
to you to-day.
10. In cases of accidental electrocution with the alternating or
the continuous current, rhythmic excitations with the Leduc cur-
rent should be used for purposes of resuscitation.
11. My excellent colleague, Professor Battelli, of Geneva, crit-
icized this method at the Congress of French Alienists and Neu-
rologists, held at Geneva, Switzerland, August 1-7, 1907, saying
that the procedure would be useless in accidental electrocution in
man, because death was instantaneous in such cases. It should
be remembered, however, that in accidental electrocution of man
death is not always instantaneous; on the contrary, observation
shows that the majority of such subjects continue to breathe for
some time, breathing being suspended after the physician has
administered some ineffectual remedy — such as "smelling salts"
or similar agents. It should be borne in mind that such subjects
suffer from paresis of the respiratory and cardiac centres ; as
soon as the patient stops breathing, artificial respiration by means
of rhythmic excitations should be practiced — until the patient
resumes his spontaneous respiration. Besides causing maximum
chest expansions these excitations also cause cardiac contractions
to take place.
II. — Experiments on Dogs. Old Technique — the Ani-
mal's Head Remaining in the Circuit During the Rhyth-
mic Excitations. — The dog's heart and respiratory centres are
highly sensitive to electric currents ; and when using the old
technique for purposes of resuscitation it is difficult or impossi-
ble to revive a dog subjected even to a minimum potential that
causes apparent death to take place. Even the Leduc current
used for the rhythmic excitations fails to bring back to life such
dogs — if the old technique is used for the rhythmic excitations.
It is well to recall that the old technique consists of using the
lethal potential for the rhythmic excitations, the electrodes re-
maining in their usual places: the cathode at the head and the
anode at the lower part of the spine.
I lost a whole series of dogs which I tried to revive according
to the old technique. The condition of the dog when I try to
RESUSCITATING ELECTROCUTED ANIMALS.— Robinovitch. 133
revive it is generally as follows : Spontaneous respiration is abol-
ished, the blood pressure in the carotid artery has fallen to from
four to six centimeters of mercury (simple manometer of Fran-
gois-Franck) and the animal remains in a condition of apparent
death.
Voltage Necessary to Resuscitate Dogs in a Condition of Ap-
parent Death Caused by Electric Shock — Using the Old Tech-
nique.— As I lost every dog which I tried to revive with rhythmic
excitations of the lethal potential, I reduced the potential : in-
stead of 80 to no volts, I used 5 to 10 volts of the Leduc cur-
rent. This change of voltage enabled me to save many dogs in a
condition of apparent death from electric shock, but still a large
number of these animals succumbed regardless of the rhythmic
excitations practiced with a small voltage.
III. — Exclusion of the Animal's Head From the Circuit
When Practicing the Rhythmic Excitations for tpie Pur-
pose OF Resuscitation. — My new technique consists of an impor-
tant change of the position of the cathode; instead of remaining
at the head — as was the case in my previous experiments, the
head is excluded from the electric circuit during the rhythmic
excitations, and the cathode is placed at the back of the chest.
I changed the position of the cathode in order to exclude from the
circuit the bulbar cardiac and respiratory centres. With the
cathode at the back of the chest and the anode at the end of the
spine — the great respiratory muscles are all in the circuit during
the rhythmic excitations. The reasons that led me to make this
change in the position of the electrodes were as follows below :
1. The fatal effect of rhythmic excitations (caused by electric
currents of lethal potential) on the respiratory and cardiac cen-
tres of dogs in a condition of apparent death, due to an electric
shock.
2. In July, 1907, while studying the state of the brain during
electric epilepsy I observed that the brain substance became
markedly paler than normal during the four seconds of the pass-
age of the epileptogenic electric current (see my paper on the
"General and Cerebral Blood Pressure in Electric Epilepsy,"
Journal of Mental Pathology, Vol. VIII, No. 3, 1907).
There was every reason to believe, therefore, that while prac-
ticing the rhythmic excitations for the purpose of resuscitation I
also caused momentary anemia of the central nervous system in
general and of the central cardiac and respiratory centres in par-
ticular. It was self-evident that this anemia — repeated with
each rhythmic excitation — was undesirable : contraction of the
blood vessels was a detriment when the animal's heart was at the
134 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 3.
point of paralysis — the carotid blood pressure registered being
from 4 to 5 centimeters (simple manometer of Frangois-Franck) .
3. Production of artificial respiration and cardiac beats by
means of rhythmic excitations could be useful on condition that
the central respiratory and cardiac centres be excluded from the
electric circuit and free from repeated asphyxia caused by each
rhythmic shock.
Respiratory and Cardiac Reaction in Relation to the New
Technique — the Head Being Excluded from the Circuit. Higher
Voltage Required for the Production of Ample Respirations. —
In order to practice artificial respiration according to my new
technique I proceed as follows below:
The animal's fur is closely cut in three places — corresponding
to three parts of the body where the electrodes should be ap-
plied : at the head, at the back of the chest and at the lower part
of the spine. The electrode at the head measures about lo x lo
centimeters, and the other two electrodes measure each about
II X 18 centimeters. Each of the larger electrodes is put upon
the Claude-Bernard cradle — in positions corresponding to the
shaven parts on the animal's back; and when the dog is put into
the cradle, the respective electrodes are pressed closely around
the corresponding parts of its body. When the head and paws
are tied to the cradle, the head electrode is fixed by means of two
rubber rings.
The electrode at the lower part of the spine is always the
anode ; the electrode at the head is the cathode for the time being.
The animal is now subjected to electric anesthesia (see my paper
on "Electric Anesthesia. Its Use in Laboratory Work," Journal
OF Mental Pathology, Vol. VIII, No. 3, 1907). The carotid
artery is exposed and connected with the manometer. A lethal
current is now sent through the dog's body and is kept up until
apparent death sets in: absence of spontaneous respiration, the
carotid blood pressure registering between 4 and 6 centimeters
of mercury. An assistant quickly frees the head, drops the head
cathode, substitutes the wire of the chest electrode in the small
mercury interrupter (the chest electrode is now the cathode),
frees the forepaws, seizes the tip of the tongue with a pair of
surgical clamps, cleanses the mouth of all mucus and maintains
the dog's mouth wide open — by lifting the lower jaw by its fur
and keeping the tongue close to this jaw.
Meanwhile, the operator is practicing rhythmic excitations
with a sufficient potential to cause maximum respiratory expan-
sions. The rhythmic excitations are practiced for one second and
at intervals of from two to three seconds — according to the
RESUSCITATING ELECTROCUTED ANIMALS.— Robinovitch. 135
gravity of the lethal shock and particularly according to the
respiratory reaction.
In favorable cases the expiratory movements that follow the
chest expansions are so forceful that they cause a noise that is
heard at a distance in the laboratory. From ten to thirty rhyth-
mic excitations are generally necessary to restore spontaneous
respiration. But in some cases, that seem hopeless, I have often
witnessed the appearance of spontaneous respiration after a lapse
of from two to three minutes — during which the rhythmic excita-
tions have been kept up.
When the proper voltage is used and the respiratory reaction
is sufficient, the following conditions prevail : the chest expands to
its maximum capacity with each rhythmic excitation ; the tongue
that was flabby and fell to the roof of the mouth (the animal is on
its back) assumes marked tonicity and is projected forward
along the floor of the mouth; the diaphragm pushes before it all
the visceral organs ; the forepaws project upward (the animal
is on its back) with great force, and the great mass of respira-
tory muscles included in the circuit enters into play with great
vigor. The heart also responds to every rhythmic excitation.
A greater voltage is needed when the cathode is at the chest
than when it is at the head. When it is at the chest I generally
use from 20 to 40 volts or more of the Leduc current. When the
induction current is used (Dubois-Raymond apparatus, coil No.
2) I shift the coil along the scale until a sufficient potential is
obtained, causing ample respiratory reaction; the coil may have
to be placed between 5 and 0 centimeters of the scale. The opera-
tor should judge after the first respiratory reaction whether or
not the potential is sufficient; he should increase or decrease the
voltage according to requirements — by turning the handle of the
reducer of potential or by shifting the position of the coil — ac-
cording to the current used for the rhythmic excitations.
I also wish to point out the fact that artificial respiration caused
by rhythmic excitations with electric currents is superior to all
other forms of artificial respiration known to us to-day.
The operator should bear in mind an important detail con-
nected with this process of resuscitation: he should watch care-
fully for the appearance of the first spontaneous respiration and
should stop the rhythmic excitations as soon as he notices the
slightest spontaneous respiration. Death is often caused by the
encroachment of an artificial respiration on a spontaneous respi-
ration.
But if the animal stops breathing spontaneously, the operator
should quickly resume the practice of the rhythmic excitations
136 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 3.
and should continue them until the animal again begins to breathe
spontaneously.
The dogs on which these experiments have been made were
of various sizes and breeds, ranging in weight between ten and
eighty pounds.
When the head is excluded from the circuit, good results are
obtained with various currents. In the near future I hope to
present in detail researches into the comparative value of various
electric currents used for rhythmic excitations to resuscitate
animals in a condition of apparent death caused by electric shock,
chloroform (see my paper entitled "The Method of Resus-
citating Animals in a Condition of Respiratory Syncope. Caused
by Chloroform," Journal of Mental Pathology, Vol. VIII.,
No. 3, 1907), ether, etc.
For the present I wish to point out the utility of the induction
current and the Leduc current for the purpose of resuscitating ani-
mals in a condition of apparent death, caused by electric shock,
chloroform, ether, etc. The utility of the induction current is of
particular interest, because it can be procured and handled more
readily than can a current requiring complicated instrumentation.
I am indebted to Professor Rouxeau, of Nantes, for his kind
advice in this work.
GENERAL AND CEREBRAL BLOOD PRESSURE
DURING AN ATTACK OF ELECTRIC
EPILEPSY.^
A PRELIMINARY COMMUNICATION.
By Louise G. Robinovitch, B. es L.^ M: D., Paris, Member,
Neii) York Academy of Medicine; Member, American
Medical Association; Foreign Associate Member,
Medico-Psychological Society, Paris.
I. Electric epilepsy of which I speak in this paper is produced
by a direct electric current interrupted no times per second and
passing one-tenth of the entire period, as is explained in my Paris
thesis, 1906, ''Sommeil electrique, epilepsie electrique et
electrocution."
* Presented at the Congress of French Alienists and Neurologists, held
at Geneva, Switzerland, August 1-7, 1907.
Presented at the International Congress of Psychiatry, Neurology and
Psychology, held at Amsterdam, Holland, September 2-7, 1907.
CEREBRAL BLOOD PRESSURE IN EPILEPSY.— Robinovitch. 137
2. Electric epilepsy is induced by passing the above mentioned
current through an animal's body during a period of four sec-
onds. The cathode is fixed at the head and the anode at the
lower part of the spine. For a rabbit the required potential is 55
volts; for a dog — no volts.
3. The tonic phase of the epileptic attack begins as soon as the
current begins to course through the animal's body.
4. The blood pressure begins to increase a few seconds after
the closing of the circuit; it is perhaps more correct to say that
the increase of the blood pressure is noticed immediately after
the opening of the circuit. The blood pressure increases pro-
gressively and reaches its maximum when the clonic convulsions
are at their maximum. Then, as the clonic convulsions decline,
the blood pressure decreases accordingly, falling gradually to
the normal level with the final disappearance of the clonic con-
vulsions.
Cerebral Blood Pressure. — The brain of a dog is exposed
by trephining its skull (during electric anesthesia: see my paper
on "Electric Anesthesia. Its Use in Laboratory Work," Journal
OF Mental Pathology, Vol. VIII., No. 3, 1907), and the
epileptic attack is induced as is explained in my thesis cited
above.
1. During the period of the passage of the current (four sec-
onds) the brain seemed to me to grow considerably paler than
normal (one of two colleagues who were present at this operation
did not consider this pallor sufficiently marked to warrant affirm-
ative opinions on the subject).
2. After the opening of the circuit and during the continua-
tion of the tonic phase of the attack the cerebral matter becomes
progressively pink in color; the cerebral vessels become visibly
dilated as the clonic convulsions take place, and this dilatation
causes the vessels to reach twice or three times their normal size
at the moment when the clonic convulsions are at their maximum.
Condition of the Cerebral Mass During an Attack of
Electric Epilepsy. — i. The cerebral mass exposed by trephin-
ing begins to increase in volume as soon as the cerebral blood
vessels begin to increase in volume — after the breaking of the
circuit. And the cerebral mass continues to increase progres-
sively in volume in proportion to the increase of the blood pres-
sure— while the tonic and the clonic convulsions are being mani-
fested. The exposed cerebral mass finally increases to such an
extent that it protrudes from the cranial opening in the shape of
a hernia; the maximum size of this hernia corresponds to the
maximum intensity of the clonic convulsions.
138 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 3.
2. The cerebral hernia begins to decrease in volume with the
decrease of the intensity of the clonic convulsions, and the cere-
bral hernia returns to its normal position within the cranial
cavity when the clonic convulsions cease.
3. The general blood pressure in electric epilepsy is presented
by tracings pubHshed in my thesis cited above as well as in the
tracings which I have the honor of presenting to you to-day.
4. The cerebral blood pressure during an attack of epilepsy
was studied and published by Dr. V. Magnan, thirty years ago
(Legons cliniques sur les maladies mentales, Paris). His re-
searches deal with epilepsy caused by absinthe. My experiments
— on electric epilepsy in dogs — show similar results as regards
the cerebral blood pressure.
I present my sincerest thanks to Dr. Rouxeau, Professor of
Physiology, School of Medicine, Nantes, for his collaboration in
this work.
July 15, 1907.
ELECTRIC ANESTHESIA. ITS USE IN LABORA-
TORY WORK.*
By Louise G. Robinovitch, B. es L._, M. D., Paris, Member,
Nezv York Academy of Medicine; Member, American
Medical Association; Foreign Associate Member,
Medico -Psychological Society, Paris..
In my paper entitled "Electric Sleep," etc., published in the
Journal of Mental Pathology_, Vol. VII., No. 4, 1905, I men-
tioned the fact that I had experienced complete anesthesia in
my forearm while it was being subjected to electric anesthesia.
In my Paris thesis, entitled "Sommeil electrique, epilepsie elec-
trique et electrocution," presented July 5, 1906, I published com-
parative studies of anesthesia of long duration, induced by ether,
chloroform and electric currents — respectively, showing that in
laboratory work electric anesthesia was preferable to the other
two forms of anesthesia for many reasons; on the date of pre-
sentation of my thesis I stated to my jury that I had used electric
anesthesia for laboratory work and had obtained good results.
* Abstract presented at the International Congress of Psychiatry, Neu-
rology and Psychology, held at Amsterdam, Holland, September 2-7, 1907.
ELECTRIC ANESTHESIA IN LABORATORY WORK.— Robinovitch. 139
The tracings of the blood pressure, temperature and respiration
during electric sleep of long duration are pubHshed in my thesis
cited above. The longest duration of this anesthesia was re-
corded by me in the same thesis, 8 hours and 20 minutes. The
advantages of electric anesthesia are as follows below :
1. The blood pressure, respiration and temperature remain
about normal, even when the anesthesia is prolonged for eight
hours or a longer period of time.
2. Chloroform or ether anesthesia m animals causes death if
prolonged for two hours.
3. Electric anesthesia can be induced not only centrally, but
also locally or regionally.
4. I have been using electric anesthesia in laboratory opera-
tions on animals since the date cited above and have never lost
any animal from the effects of this anesthesia.
5. The voltage necessary to induce electric anesthesia is so
small (from 5 to 10 volts for a dog weighing from 10 to 80
pounds) that danger to life from this potential is entirely out of
the question.
6. Electric anesthesia is suspended as soon as the circuit is
broken and there are no after effects from this form of anesthesia.
7. The operations which I have performed with electric anes-
thesia are important, as they comprise trephining of the skull and
exposure of the brain, exposure of the carotid artery and the
pneumogastric nerve, abdominal section, etc.
Since the publication of my papers on electric anesthesia, Pro-
fessor Tuffier and his interne. Dr. Jardry, have tried this form
of anesthesia on dogs (Presse Medicate^ April 20, 1907).
Anesthesia produced by electricity differs from that caused by
chloroform or ether in some particulars: there is a given degree
of satisfactory electric anesthesia that may be induced by a given
voltage; if this potential is decreased by one or two volts — the
anesthesia ceases and the animal wakes up; if the potential is in-
creased by one or two volts — the animal becomes agitated by a
convulsive tremor in its whole body, crying out with pain.
From the point of view of anesthesia as we understand the term
in surgery, electric anesthesia does not correspond exactly to
chloroform or ether anesthesia: during electric anesthesia the
superficial reflexes are exaggerated, the animal is very apt to
open its eyes, lift its head, make some defensive movements and
even cry out — then fall back on the operating table and remain
quiet again. This may be repeated several times during a long
operation.
To judge from the anesthesia I experienced in my forearm in
140 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 3.
the experiment made in 1905, it is legitimate to conclude that ani-
mals subjected to this form of anesthesia do not suffer pain dur-
ing an operation and that the defensive movements are due to
incomplete abolition of consciousness.
The results obtained from the use of electric anesthesia in my
daily laboratory work during the last two years have been satis-
factory— there having been no case of death from this anesthesia
among the numerous animals subjected to this sleep. I recom-
mend this form of anesthesia for laboratory surgery; electric
anesthesia should replace chloroform and ether anesthesia in
laboratory work.
While operating on animals subjected to electric anesthesia the
operator's hands are in the electric circuit, and he experiences
now and then slight tingling in his fingers. The question of ap-
plication of electric anesthesia in man is as yet to be studied. The
potential necessary to induce central electric anesthesia in man
is probably from 50 to 80 volts, more or less. The surgeon's body
may be excluded from the circuit by spreading a rubber sheet
under his feet ; but this does not exclude his hands from the cir-
cuit, and tingling of the fingers is a serious drawback during a
major operation requiring delicate handling. Rubber gloves may
also be considered as a means of keeping the operator's hands
out of the electric circuit.
Electric anesthesia causes abortion in pregnant animals. The
bowels are always emptied during electric anesthesia.
The electric current necessary to induce electric anesthesia is a
direct current interrupted no times per second and passing one-
tenth of the entire period.
For details of the technique see my papers cited above.
METHODS OF RESUSCITATING ANIMALS IN A
CONDITION OF RESPIRATORY AND CAR-
DIAC SYNCOPE CAUSED BY CHLORO-
FORM. VARIOUS ELECTRIC CUR-
RENTS USED. IMPORTANCE OF
EXCLUDING FROM THE CIR-
CUIT THE CENTRAL NER-
VOUS SYSTEM. EXPERI-
MENTAL STUDY.*
A PRELIMINARY COMMUNICATION.
By Louise G, Robinovitch, B. es L. M.D., Paris; Member, Nezv
York Academy of Medicine; Member, American Medical
Association; Foreign Associate Member, Medico-
Psychological Society, Paris.
Animals in a condition of respiratory and cardiac syncope may
be resuscitated by means of rhythmic excitations caused by electric
currents in the same manner as I practice rhythmic excitations
for the purpose of resuscitating animals in a condition of appar-
ent death due to electric shock (see my paper ''Methods of Re-
suscitating Electrocuted Animals. Different Effects of Various
Electric Currents According to the Method Used. Importance
of Excluding the Central Nervous System from the Circuit during
Resuscitation," Journal of Mental Pathology, Vol. VIII, No.
3,1907)-
The preliminary operation for the purpose of connecting the
carotid artery with the manometer (simple manometer of Fran-
Qois-Franck) is performed while the animal is under the Influence
of electric anesthesia (see my paper "Electric Anesthesia. Its Use
in Laboratory Work," Journal of Mental Pathology, Vol.
VIII, No. 3, 1907).
Mode of Procedure. — The Claude Bernard cradle is put upon
the operating table and two electrodes, measuring each about 11
X 18 centimeters, are placed in the groove of the cradle — so as to
correspond to two shaven parts on the animal's back ; one — on the
back of the chest beginning below the root of the neck; the
* Part of the experiment presented by invitation at the Moabit Kranken-
haus, Berlin, Germany, September-October, 1907.
Part of the experiment presented by invitation at the Rudolf Virchow
Krankenhaus, Berlin, Germany, October, 1907,
142 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 3.
Other — at the lower part of the spine. The animal's fur is closely
cut in three parts of its body : at the back of the chest, at the lower
part of the spine and at the head. When the animal is put on its
back — in the Claude Bernard cradle, — each of the two shaven
parts of its back corresponds to one of the large electrodes. The
animal's head and paws are now tied to the cradle, and the head
electrode, measuring about lO x lo centimeters, is fixed on the
head by means of two rubber rings. The large electrodes on the
back are pressed closely around the chest and back, and the
weight of the animal keeps them in place. The electrodes and the
animal's skin are thoroughly wet with a normal salt solution.
The electrode at the lower part of the spine is the anode ; the elec-
trode at the head is the cathode — during the preliminary opera-
tion— while the animal is under the influence of electric anesthesia.
The wire of the electrode at the back of the chest is not in the
circuit for the time being. Electric anesthesia is now induced by
closing the circuit of a Leduc current, as follows below :
The negative pole of an electric source of a direct current is
connected with the reducer of potential, a Leduc interrupter (no
interruptions per second, the current passing i/io of the entire
period) and finally — with the electrode at the head. The positive
pole is connected with a milliamperemeter, a small mercury inter-
rupter and with the electrode at the lower part of the spine. A
voltmeter is put in derivation. The circuit is closed by means of
the mercury interrupter and the voltage is gradually increased by
shifting the handle of the reducer of potential. The animal shows
slight excitation and tremulation of the entire body until the
proper voltage is reached. The proper voltage for a dog is from
5 to lo volts, the milliamperemeter indicating from 1.5 to 3 milli-
amperes. The animal now remains quiet and may be operated
upon. The carotid artery is now exposed and connected with the
manometer. Electric anesthesia is now discontinued, and the
animal is chloroformed. As soon as the chloroform anesthesia is
complete, an assistant frees the animal's head and paws, drops the
head electrode, connects the wire of the chest electrode with the
mercury interrupter, while the operator catches hold of the tip
of the animal's tongue with a pair of surgical clamps and cleanses
the mouth of all mucus. The blood pressure falls during the
chloroforming, but always rises to the extent of from 2 to 4 centi-
meters of mercury while the animal's mouth is kept open ; but
the blood pressure falls again as soon as the chloroforming is re-
sumed ; as soon as this pressure is registered by some 5 or 6 centi-
meters of mercury, the operator changes place with the assistant ;
the latter administers the chloroform, keeps the animal's mouth
RESUSCITATION FROM CHLOROFORM SYNCOPE.— Robinovitch. 143
clean of mucus and is ready to discontinue the chloroform as
soon as respiratory or cardiac syncope is induced — the blood pres-
sure generally registering at such a time from 3 to 5 centimeters
of mercury. The operator begins to practice rhythmic excitations
a few seconds after the onset of the respiratory syncope — when
spontaneous respiration seems to be im^possible. Tf cardiac syn-
cope sets in first, the rhythmic excitations should be begun at
once.
Voltage Necessary for Causing Ample Respiratory Reac-
tion— the Central Nervous System Being Excluded from
the Circuit. — The first rhythmic excitation may be caused with
from 20 to 40 volts of the Leduc current. The voltage is then in-
creased or decreased — according to the amplitude of the respira-
tory reaction. The rhythmic excitations are practiced during
one second and at intervals of from 2 to 3 seconds, — according to
the gravity of the syncope and especially according to the energy
of respiratory and cardiac reaction. In the majority of cases,
spontaneous respiration and cardiac reaction takes place after
some 10 or 20 rhythmic excitations have been practiced. As
soon as the first spontaneous respiration is noticed, the rhythmic
excitations should be suspended. Death is apt to be caused ins-
tantly— if a rhythmic excitation is allowed to encroach on a spon-
taneous respiration. In many cases spontaneous respiration does
not take place for a long time — 2 or 3 minutes ; but the operator
should keep on practicing the excitations even when the case
seems hopeless ; I have obtained many tracings showing the on-
set of spontaneous respiration after a period of from two to three
minutes, — during which the rhythmic excitations have been prac-
ticed— although the cases seemed to be hopeless.
Respiratory and cardiac reaction may be obtained with a smaller
voltage if the head is included in the circuit. But there is great
danger in allowing the central nervous system to remain in the cir-
cuit during the rhythmic excitations. I have obtained fatal results
in several series of experiments in which the head was in the
circuit during the rhythmic excitations. For details on this sub-
ject see my paper "Methods of Resuscitating Electrocuted Ani-
mals," etc., cited above.
Cardiac Reaction During the Rhythmic Excitations. —
The heart contracts with every rhythmic excitation. If respira-
tory syncope sets in before the cardiac syncope, the operator
watches the pressure in the manometer and times the rhythmic
excitations so that they do not encroach on cardiac contractions.
The rhythmic excitations are suspended as soon as the first spon-
taneous respiration takes place; the heart action then becomes
j^ THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 3.
gradually stronger in proportion to the increased energy of the
spontaneous respiration. But there are exCjCptional cases in
which the heart stops beating before respiratory syncope sets in,
the blood pressure falling abruptly to some 4 centimeters of mer-
cury and remaining stationary at that level. Respiratory syncope
then follows immediately the cardiac syncope; such respiratory
syncope may be replaced by spontaneous respiration — after a few
rhythmic excitations have been practiced ; but the operator is con-
fronted with great difficulty in restoring the heart action by means
of rhythmic excitations : the animal is apt to be killed instantly if
a rhythmic excitation is allowed to encroach on a spontaneous
respiration; and the animal is certain to succumb — if rhythmic
respirations are not practiced in order to restore cardiac function.
Hence, — the operator must practice rhythmic excitations — but
only at chosen moments — between the inspiratory movements, or,
to be more precise — immediately after each expiratory movement.
I have cardiac and respiratory tracing of such a case, in which
rhythmic excitations had to be practiced during a period of one
minute and forty-five seconds — before spontaneous cardiac con-
traction took place. The respiratory tracing represents a long
series of alternations of spontaneous respirations and rhythmic
excitations.
Respiratory Reaction During the Rhythmic Excitations.
— The animal's mouth is kept open and its tongue is held close to
the lower jaw — without hindering its movements during the res-
piratory acts. Each rhythmic excitation is followed by an in-
spiration of maximum amplitude and by a corresponding expira-
tory movement; if properly performed, the inspirations are fol-
lowed by forceful expirations, the noise of which is heard in the
laboratory at a distance. The force of respiratory reaction is as
marked as it is interesting to observe: the chest dilates to its
maximum capacity ; the lifeless tongue that fell in a flabby mass
to the roof of the mouth (the animal is on its back) assumes
marked tonicity during the rhythmic excitations and stretches out
along the floor of the mouth ; as the chest dilates to its maximum
capacity, the forepaws project with great vigor upward (the ani-
mal is on its back), the diaphragm contracts with great force and
pushes the visceral organs downward, while the hind paws also
contract vigorously. The breaking of the circuit is followed by
correspondingly vigorous expiratory movements.
Abnormal Respiratory and Cardiac Syncope. — In excep-
tional cases spontaneous respiration or cardiac beats may cease —
after they have been brought about by means of rhythmic excita-
tions. The operator should immediately resume the practice of
RESUSCITATION FROM CHLOROFORM SYNCOPE.— Robinovitch. 145
rhythmic excitations and try to resuscitate the animal as he did
in the first place.
Different Electric Currents Used. — I have used various
electric currents for the purpose of causing rhythmic excitations
during respiratory and cardiac syncope. The same method was
used with all the currents, — one electrode being applied at the
back of the chest and the other at the lower end of the spine. I
have obtained satisfactory results from the use of various currents.
The mode of aplication of the Leduc current is explained above.
For the induction current I use the Dubois-Raymond apparatus,
running on 8 volts of accumulators, coil No. 2. The two electrodes
on the animal's back are connected with this apparatus and the
mercury interrupter; when the circuit is closed, the rhythmic
excitations are practiced as is explained above, and the voltage is
increased according to the respiratory and cardiac reaction — by
shifting the coil toward or from O on the scale.
The method of resuscitating animals in a condition of respira-
tory or cardiac syncope due to poisoning with chloroform or ether
is of practical importance in surgery. The method of administer-
ing anesthetics is perfected to-day, but occasional cases of chloro-
form or ether syncope still present themselves from time to time.
I was highly pleased, therefore, when the leading surgeons of
Berlin, Germany, accepted the demonstration of my experiments
in the line of work with the consideration due to the importance
of the subject (see Dr. Gradenwitz's abstract of some of my ex-
periments made in Berlin, September-October, 1907, in "Western
Electrician," November 23, 1907, article entitled "Electric Sleep
and Resuscitation from Electric Shock").
All the animals used in these experiments were dogs of various
breeds, ranging in weight from 10 to 80 pounds. The amount of
chloroform used varied from 15 to 70 grams. There is no corre-
spondence between the size of the dog and the amount of chloro-
form necessary to cause respiratory or cardiac syncope.
There are many other forms of cardiac and respiratory syncope
in which it seems useful to try the method of resuscitation con-
sidered in this paper. I have a series of experiments relating
to this method of resuscitation of animals in a condition of syn-
cope due to morphine and hyoscyamin poisoning; some of the
results obtained are satisfactory.
In the near future I hope to present a study of the comparative
value of various electric currents for the purpose of resuscitating
animals in a condition of respiratory and cardiac syncope due to
poisoning with chloroform, ether, morphine, etc.
The Journal of Mental Pathology
Edited by Louise G. Robinovitch, B. is L., M.D.
Vol. VIII. 1907. No. 3.
STATE PRESS, Publishers,
L. G, ROBINOVITCH, M.D., PRES.,
28 W. 126th St.,
New York.
MSS. and Communications should be addressed to the Editor,
28 West 126th Street, New York.
Address bulky mail matter to P. O. Box 1023, New York.
This Journal is published in volumes of five issues each. Price of each
volume, $2.50. Single copies, 50 cents.
Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope.
NICOLAS VASCHIDE.
Nicolas Vaschide died October 13, 1907, at his home, in Paris.
The scientific world who knew Nicolas Vaschide by the reputation
he had made for himself as a psychologist is astonished to learn
that he was only a young man — in the prime of life. He was
born at Buzeu, Roumania, December, 1873. During the last
ten years Nicolas Vaschide contributed scientific papers to every
leading publication on psychology, psychiatry and philosophy. He
was a strenuous worker, and the enormous yearly output of his
excellent papers and volumes treating of psychology, psychiatry
and philosophy astonished even the most energetic workers in our
profession.
His method of study of psychology is familiar to us all : it was
clinical or based on laboratory experiments. It was individual
and as forceful as was the personality of Vaschide himself.
His contributions to this Journal are familiar to our readers ;
and the enumeration of a few of his researches that follows below
shows how broadly he had outlined his work in psychology.
NICHOLAS VASCHIDE. I47
N. Vaschide and H. Pieron. — The Symptomatic Value of
Dreams, Journal of Mental Pathology, Vol. I, No. 2.
N. Vaschide and Vurpas. — On the Mental Analysis, Journal of
Mental Pathology, Vol. II, No. 2.
N. Vaschide and Meimier.— On the Cutaneous Temperature
in the General Paralytics, Journal of Mental Pathology, Vol. Ill,
Nos. 2-^.
N. Vaschide and Meunier. — Contribution to the Study of Men-
tal Impulses, Journal of Mental Pathology, Vol. V, Nos. 4-5.
N. Vaschide and M. Lahy. — La technique de la mesure de la
pression sanguine particulierement chez I'homme, Arch. Gen-
eral es de Medecine, Vol. VIII, 1902.
N. Vaschide and M. Lahy. — La technique sphygmographique,
Revue de medecine^ 1904.
N. Vaschide, Pieron and Toulouse. — Technique de Psychologic
experimentale, Doin, Paris, 1904.
N. Vaschide and Vurpas. — La logique morbide; preface by
Ribot, Rudeval, Paris, 1902.
N. Vaschide and Vurpas. — Essai sur la psychologic des mon-
stres humains. Un anencephale. Un xiphopage, Rudeval, 1902,
Paris.
N. Vaschide and Vurpas. — Recherches experimentales sur la
psychophysiologic du sommeil, Academie des Sciences, March 23,
1903, Paris.
N. Vaschide and Vurpas. — Le rythme vital, Academie des Sc,
Nov. 3, 1902.
N. Vaschide and Pieron. — La psychologic du reve au point
de vue medicale, Masson, Paris, 1902.
N. Vaschide and Raymond Meunier. — La memoire du reve et
la memoire dans les reves. Revue de philosophie, Oct.-Dec, 1906.
N. Vaschide and Raymond Meunier. — Des caracteres essen-
tiels de I'image onirique, Annales des Sc. psychiques, October,
1903.
N. Vaschide and CI. Vurpas. — Contribution experimentale a
la physiologic de la mort, Academie des Sc, April 14, 1903.
N. Vaschide. — Recherches experimentales sur les hallucinations
telepathiques. Bull. Soc. Sc. de Bucarest, XI, Nos. 5, 6.
N. Vaschide. — Taste, — in Dictionnaire de Physiologic, Charles
Richet.
N. Vaschide. — Essai sur la psychologic de la mort (edited on
his death bed and submitted to the printers).
N. Vaschide and Raymond Meunier. — Essai sur la psychologic
de Tattention.
148 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 3.
Nicolas Vaschide was engaged in editing several volumes of
psychology — based on his experimental studies, — when he was
overtaken by a fatal illness. Editing several volumes was not an
unusual undertaking for Vaschide. While on his death bed, he
was surrounded by his manuscripts^ published papers and vol-
umes and he edited many chapters of the volumes on experi-
mental psychology he had hoped to publish. He died at this task
on the 30th day of his illness.
His numerous works that have appeared in print indicate to
some extent the latitude of his scientific activity. The brilliancy
of his work first attracted attention while he was a college boy
in his native country, and he was awarded the First Prize for
his thesis presented to obtain the degree oi A. B. at the University
of Bucarest. He came to Paris in 1895 ^^^id was soon appointed
Assistant at the Laboratory of Physiological Psychology, directed
by Prof. Binet. Later he was appointed Chief of the Laboratory
of Experimental Psychology, at Villejuif ; and finally he was ap-
pointed Adjunct Director of the Laboratory of Pathological
Psychology at Villejuif. He was Laureate of the Academy of
Medicine, Paris, and was awarded the Prize of the College de
France. He was member of the Societe Biologique, Athropolo-
gique, Sociologiqne, etc., etc.
Such was the professional activity of Nicolas Vaschide.
His reputation was international, and his death has called forth
expressions of sincerest condolence from colleagues in all parts
of the world. And those of us who knew him personally feel
that we have lost in him an excellent colleague, a warm friend
and a brilHant mind.
He leaves a widow and one son. We extend to them the ex-
pression of our deepest condolence.
BOOK REVIEWS.
L'Endeinia Qozzo-Cretinica Nellie Famlglle. Pp. 236. Rome,
1907. By U. Cerletti and G. Perusini. Previous researches
by these authors into endemic cretinism and congenital goitre
were published in this Journal. The present work is a con-
tinuation of the same studies. One hundred and four subjects
belonging to 25 families are studied in the present work. The
ascendents' histories are followed out to the fourth generation.
BOOK REVIEWS. 149
Ninety-eight of the 104 cases present marked alterations of the
thyroid gland; 45 cases present somatic and psychic symptoms
related to goitre; 5 subjects are "normal." Alterations of the
thyroid gland is a predominant feature in these cases. Only
one of these cases was the offspring of parents who seemed to
be free from goitre, but there is some question about the mat-
ter. On the other hand, there was one "normal" offspring,
whose parents and all the members of the collateral branches of
the family were afflicted with congenital goitre. Some of the
"normal" subjects, born of parents with congenital goitre present
idiocy with cerebroplegia and other disturbances that do not seem
to be related to thyroidism. The study of endemic cretinism
warrants the conclusion that it is a disease of familial type. It
is difficult to explain, however, the coexistence of cretins and
"normal" subjects in the same family. It may be supposed that
certain specific conditions of the mother during conception and
gestation have an influence on the genesis of endemic cretinism.
The authors have not been enabled to learn definitely whether
the cretins are always born in a condition of myxedema.
Lecons Cllniques sur rilysterle et I'Hypnotisme — By Dr.
A. PiTRES^ Professor of Nervous Diseases and Dean of the
Faculty of Medicine, Bordeaux. Two Volumes. Octave Doin,
Paris. These two volumes represent a collection of clinical
lectures on hysteria, its complex manifestations and on hypno-
tism. Professor Pitres treats of this subject with its usual
lucidity and erudition. The leading schools on hypnotism are
considered and clinical facts are given due credit. Both volumes
are published in large Octavo; volume No. I contains 531 pages
and 75 cuts; volume No. II, contains 551 pages and 58 cuts.
Among the various hysterical manifestations the following sub-
jects are considered : anesthesia, tremors, rhythmic spasms, spas-
mogenic and hypnogenic zones, hypnotic suggestion, attacks of
contractures, hysterical epilepsy and delirium and the various
morbid and psychic manifestations that can be induced in hys-
terical subjects during the hypnotic state. These two volumes
represent an exhaustive treatise on the subject of hysteria, its
various phenomena and its manifestations during hypnotic sleep.
Le Langage Musical et ses Troubles Hysteriques. — By Dr.
J. Ingegnieros, Professor, University of Buenos-Ayres. The
psychology of musical evolution in man is presented in the first
part of the work. The psycho-physiology of musical emotions
is then considered — in relation to various degrees of musical
150 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII., No. 0.
emotivity — from the idiot to the genius. The second part of
the work is devoted to the study of musical language in hys-
terical subjects; the study deals with amusia or musical aphasia,
which is analogous to common aphasia; hypermusia and para-
musia. The author shows erudition in the handling of the sub-
ject and the volume presents interesting reading. Large octavo
volume of 208 pages, price 6 francs. Felix Alcan, Paris, 1907.
Lesions et Particullerement rion lode. Etude Physique
et Therapeutique. By Dr. Raymond Brillouet. J. B. Balliere
and Sons, Paris, 1908. This small volume of 128 pages contains
the latest studies on clinical electrolysis. The iodide salts are
especially studied and clinical cases treated with this method are
reported. An extensive bibliographic list is appended to this ex-
cellent little volume.
The Phenomenon of Conciousness in Ontogenesis. — Dr.
Lahy. — Ablation of the brain destroys the sense of consciousness.
Goltz's dog in which the cerebral convolutions had been extir-
pated, continued to live for 18 months, but the animal was not
conscious of its surroundings. In human beings gradual disinte-
gration of consciousness is exemplified in general paralytics, in
whom the cerebral cortex is progressively atrophied. An anen-
cephaliac cannot manifest any signs of consciousness. Vaschide
and Vurpas's statements about the manifestations of the anen-
cephaliac they had studied is criticised. While it may be said that
a child manifests signs of consciousness some few days after
birth, it is only after the sixth month that elementary consciousness
properly speaking may be considered (Arch, de Neurologic, Oct.,
Lumbar Puncture in Children .—Dr. Aug. Ley gives the fol-
lowing conclusions:
1. Lumbar puncture in children may be considered as harmless
if caution is observed. In children under two years of age the
puncture should be made in the lumbo-sacral region.
2. The examination of the cerebro-spinal fluid furnishes most
important diagnostic indications, and every practitioner should be
familiar with this method. At present this aid in diagnosis is
applied mostly in meningeal inflammations.
3. Lumbar puncture relieves patients sufifering from meningitis,
and has curative effects in hydrocephalus and the acute menin-
gites. The punctures should be made at repeated intervals in the
latter conditions.
4. The harmlessness of the operation warrants its being tried
in various affections, among which may be mentioned chorea,
BOOK REVIEWS. 151
whooping-cough, eclampsia, uremia and urinary incontinence
(Journal de Neurologic, No. i8, 1905).
Emotions on Witnessing Capital Punishment Prof. Si-
KORKi : physicians who have witnessed many capital punishments
say that the sight of an execution always produces a profound
impression on them. One French physician, who had witnessed
a large number of executions and who believed in the value of
capital punishment, said that regardless of his convictions on the
subject, the sight of an execution always produced a powerful im-
pression on him, leaving him saddened and depressed for some
time. The same physician says that although he does not agree
with Tarde that capital punishment should be abolished, he does
agree with him that the practice is a horrible butchery of the
human body. Dostoevski's immortal verses of the man con-
demned to death (Polejaeff) are quoted showing that the poet's
appreciation of a condemned man's psyche corresponds to the
psychiatrist's knowledge of the same. A celebrated case of capi-
tal punishment in Russia is then cited, showing that even an ac-
customed hangman is profoundly affected by performing the
duty imposed upon him by the authorities : a prisoner was in-
stigated by a desperate criminal in the same prisoti to kill an
orderly there. The prisoner was then condemned to death and
hanged. The hangman was so impressed by his own deed that he
deserted his post and killed himself. Other dramatic incidents are
also related, being direct results of the impression caused by tak-
ing a human life — lawfully. Russian thinkers are doing their best
to have capital punishment abolished (Voprossi Nervno-Psychi-
atritcheskoi Medizini, Vol. X, 1905).
On the Fibrillary Structure of the 5plnal Nervous Cells in a
Case of Myopathia. — Dr. V. M. Verzilov : the number of ner-
vous cells was not decreased and there could be no question of
cellular atrophy. Alongside with the normal cells, however, there
were cells that presented central or peripheral chromatolysis more
or less marked. In some cells the chromatic substance was en-
tirely destroyed, the cells themselves being swollen and the nuclei
displaced toward the periphery. In a large number of the cells
the neurofibrillary network remained normal, but in some cells
there was degeneration of this network — from the centre to the
periphery. The patient had been affected with the progressive
muscular atrophy for fifteen years. The good condition of the
nervous cells did not correspond to the pronounced musculaf
152 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIIL, No. 8.
atrophy (Journal Nevropatologii Imeni Korsakova, Nos. 3-4,
1905)-
The Present Status of Treatment with Light.— Dr. Grud-
ziNSKi : light is an important excitant agent of the central nervous
system as well as of the sensory nerve endings. Excitation of the
peripheral nerve endings is a necessary intermediary process, how-
ever, before the central nervous system can be reached. In frogs
excitability in general is increased under the influence of light.
Dermic excitability is also increased under the influence of light.
The influence of light on the psychic sphere is marked, as every
day experience demonstrates: fine weather makes us feel ener-
getic, while bad weather has the opposite effect. In England bad
weather causes a decrease of 10 per cent, of work accomplished
in factories as compared with the amount of work accomplished
in fine weather. In bad weather there are many more accidents
and suicides than in fine weather. Light seems to be one of the
constant stimuli necessary for the continuance of normal life. The
different effects of various colors are also well known, red and
yellow, for instance, having an excitant effect, while blue is de-
pressing in its effects. The influences of light on the various
tissues of the organism is considered in detail (Riissky Medizinski
Vestnik,VolV,]<^o. 5).
Adolescent Insanity: a Protest Against the Use of the Term
Dementia Precox. — Dr. J. C McConaghey: in 1863, Kalbaum
described a form of mental disease occurring at puberty and
rapidly terminating in dementia ; this is called hebephrenia. In
1874, the same author described the condition known as katatonia
or insanity of rigidity. These terms do not appear to have been
adopted till 1891, when Pick, under the heading of dementia pre-
cox, described cases including hebephrenia, characterized by
maniacal symptoms followed by melancholia and rapid deteriora-
tion. This term has now been extended by Kraepelin, including
under it hebephrenia and katatonia of Kalbaum together with
certain forms of paranoia that undergo early deterioration. The
author objects to the term dementia precox as applied to recent
and curable varieties of mental disease, as it is unscientific to label
a case as suffering from dementia and then to have to record such
a patient's recovery, as must often be the case under the circum-
stances. The author proposes the adoption of the term adolescent
insanity, and suggests its division into three groups: simple, de-
lusional and katatonic (The Journal of Mental Science, April,
1905).
The Journal of Mental Pathology
Vol. VIII 1909. No. 4
RESUSCITATION OF SUBJECTS IN A CONDITION
OF APPARENT DEATH CAUSED BY CHLO-
ROFORM, ETHER, ELECTROCUTION,
DROWNING, ETC. NECESSITY OF
EXCLUDING THE CENTRAL NER-
VOUS SYSTEM FROM THE CIR-
CUIT DURING THE RHYTH-
MIC EXCITATIONS. CLINI-
CAL APPLICATION OF
THE METHOD.*
By Louise G. Robinovitch, B. es L., M.D.,
Paris; Member, New York Academy of Medicine; Member,
American Medical Association; Foreign Associate Member,
Medico-Psychological Society, Paris.
(From the laboratory of Dr. V. Magnan, Directed by Dr. Robino^
vitchj Bureau of Admission, Ste.-Anne Asylum, Paris.)
Cases of chloroform syncope and even death caused by chloro-
forming for surgical purposes occur now and then ; but the
means of resuscitating such subjects are quite limited, as these
means are confined to rhythmic traction of the tongue (Laborde),
artificial respiration (Sylvestre's method), respiratory stimulants,
rhythmic contractions of the chest and even cardiac massage.
In cases of grave syncope caused by chloroform none of these
means is efficacious and death takes place even after heart beats
and spontaneous respiratory movements have been obtained dur-
ing a few minutes.
*Read and experiments demonstrated at a meeting of the Socieie
Clinique de Medecine Mentale, : Paris, November, 1908.
Experiments demonstrated at the following meetings: Nineteenth An-
nual Meeting of the American Electro-Therapeutic Association, Septem-
ber 29, 1909; New York Academy of Medicine, November 4, 1909; The
New England Association for Physical Therapeutics, November 12, 1909,
Boston, Mass.
154 ^^^ JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, ItOt.
The failure to revive subjects in a condition of grave chloro-
form syncope is due to several causes, as the mechanism of appar-
ent death caused by chloroform is not the same in all subjects:
death may be caused now by cardiac paralysis, now by respiratory
paralysis, now by synchronous paralysis of both the cardiac and
respiratory centers; sometimes death sets in slowly, gradually,
but at others, death takes place suddenly — without any warning.*
In view of these various modes of syncope, it is necessary to
have a sufficiently adequate means of resuscitation applicable to
the various cases; thus, for instance, a subject whose heart is
suddenly and profoundly paralyzed with chloroform cannot be
resuscitated by means of artificial respiration — because the circu-
lation is thereby not re-established: either because the artificial
respiration is insufficient to provoke cardiac beats, or if these
beats are brought about, they are too feeble to re-establish the
circulation.
On the other hand, in cases of profound respiratory paralysis,
the ordinary means of resuscitation are useless ; and in cases of
synchronous cardiac and respiratory paralysis, even the extraordi-
nary means of resuscitation, such as direct cardiac massage, are
also useless in grave forms ; besides, the loss of time necessitated
by the operation for the exposure of the organ and the risks in-
curred by the possible results of the operation should be borne in
mind. A detail of some importance is the fact that in the cases
of grave chloroform syncope in which direct cardiac massage had
been practiced, the subjects died within from a few minutes to
one-half hour after the successful resuscitation. We speak of
such cases that have come to our notice.
AVhen we speak of cardiac or respiratory syncope in our experi-
* The term syncope in the language of the surgeon does not corre-
spond exactly to the same term in the language of the physiologist. The
surgeon considers his subject in a condition of respiratory syncope when
there is no visible sign of respiration. But physiologically the sheer ab-
sence of visible respiratory movements does not indicate that there is ar-
rest of respiration, because this function may continue without causing
chest movements perceptible to the eye or hand. Cardiac syncope — surgi-
cally speaking — is a condition in which the pulse in the arteries cannot be
felt with the fingers and when the heart beats cannot be heard with the
•ar. But physiologically, the heart may continue to beat feebly without
lausing perceptible impulses to the finger applied to the artery or to the
car applied to the cardiac area. Physiologically — in our experiments — we
say that there is cardiac syncope when the blood pressure in the isrge
arteries ceases to be registered by the manometer, the mercury column
falling to zero. Zero of pressure in these experiments is not indicated by
zero on the scale for physical reasons, the level of the mercury reaching
to from 2 to 4 mm. But the blood pressure is zero, nevertheless.
RESUSCITATION.— Dr. Robinovitch. 155
ments, these terms are used in the physiological sense as is ex-
plained in the foot-note.
In our experiments we have tried the application of a method of
resuscitation of practical value in cases of grave syncope and
apparent death; a method that could be applied without great
loss of time, and that would produce within a minimal loss oi
time synchronous artificial respiration and heart beats. For this
purpose we use various electric currents that produce respiratory
movements of required amplitude accompanied by cardiac beats;
the latter are feeble at first, but their force is gradually increased
with the good progress of the respiration ; and when spontaneous
respiration is sufficiently established the spontaneous heart beats
also increase in amplitude and the application of the electric cur-
rents may then be withdrawn.
Some details of the modus operandi are given below.
The blood pressure is taken in the carotid or femoral artery.
The surgical operation for exposing either one of these arteries is
performed under the influence of electric anesthesia (i) which
we were first to use for the first time in 1906 as a substitute for
ether or chloroform, and have continued its use up to date in our
laboratory surgery. The animal is fixed in the Claude-Bernard
cradle, the artery exposed and connected with the manometer ; the
pneumograph is adjusted to the chest ; the animal's paws and head
are fixed in their respective places. This precaution is taken
because chloroform produces marked excitement of the animal
even during the electric anesthesia. The chloroforming is pushed
intensively with the purpose of causing apparent death of the
animal as quickly as possible. For this purpose the chloroforming
is necessarily performed rather roughly — by reducing — by means
of a cotton tampon — the entrance of air into the chloroform fun-
nel. The funnel is an improvised affair, made of soft rubber
sheeting so that it can be moulded around the animal's snout and
the air excluded as much as possible. Absorbent cotton saturated
with chloroform is placed in the narrow part of the funnel and
the wide part is fitted closely around the snout. Electric anes-
thesia is suspended before the chloroforming is begun.
I. Dr. Louise G. Robinovitch. — Electric Sleep. An Experimental Study
with an Electric Current of Low Tension. Illustrated with Cardiac and
Respiratory Tracings, The Journal of Mental Pathology, Vol. VII. No 4
1905.
Sommeil electrique, epilepsie electrique et electrocution; Paris Thcsii,
1906.
Electric Anesthesia or Electric Sleep; Reference Handbook of the
Medical Sciences, Wood and Co., 1907.
X56 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, 1909.
Marked agitation characterizes the first stage of chloroforming :
the animal struggles with all its might to free itself ; its respiratory
movements are now of maximum amplitude, so that the rubber
sheeting of the pneumograph is apt to be ruptured unless precau-
tion is taken by opening the safety valve of the apparatus. The
blood pressure that registered i8 cm. of mercury before the
chloroforming was begun, mounts abruptly to 20, 25, 28, 30 cm.,
or even higher. During the stage of agitation the blood pressure
may become so high that the indicator in the manometer (of
Frangois-Franck) is expulsed from the tube. For these experi-
ments and for those of resuscitation of electrocuted subjects we
use Marey's manometer, modified according to our indications, so
that the m.ercury may rise to 45 cm. without inconvenience.
The dose of chloroform necessary to cause apparent death
varies with each animal, because the mechanism of death by this
poison varies with each animal. In dogs, apparent death may be
caused with from lo to 40 grams, — irrespective of the size or
the weight of the animal.
The duration of chloroforming for inducing apparent death'
also varies with each animal.
Our Method of Resuscitation. — Before the animal is put on
the Claude-Bernard rack everything is prepared for the practice
of resuscitation: the dog's back is shaven in two parts, — one in
the dorsal and the other in the lumbar region; electrodes are
applied — one to each shaven part; the cathode is at the dorsal
region and the anode at the lumbar region. It is of the greatest
importance to exclude the dog's head from the circuit. The elec-
trode is composed of a zinc plate, covered or not with chamois,
but always covered with a thick layer of absorbent cotton, wet
with a saline solution 7 per 1000. The electrodes used for dogs
of large size measure 12 by 25 cts.
Various electric currents are prepared and ready for utilization
before the chloroforming is begun: the alternating current and
the continuous currents, usually of no volts (city current), the
continuous current supplied by storage batteries of high capacity
(200 amperes), a current of frequent interruption (from 6,000 to
12,000 per minute, period i/io), induction current furnished by
a coil especially made according to our indications ; the diameter
of the wire is not under 0.6 mm. (2).
In the application of electric currents that have differentiated
poles, the cathode should be dorsal and the anode lumbar.
2. Dr. Louise G. Robinovitch. — I. De remploi des courants electriques
pour le rappel a la vie, dans les cas de mort apparente causee par le chlo-
roforme ou par I'eledtrocution : Necessite d'exclure du circuit la tetc.
RESUSCITATION.— Dr. Robinovitch.
157
As soon as the chloroforming is sufficiently far advanced, so
that the arterial blood pressure is low and the respiration slow,
the animal approaching apparent death, the anterior paws are
untied and the head set free ; the tip of the tongue is clasped with
a pair of forceps and the saliva and mucus in the mouth and
throat are rapidly cleansed with absorbent cotton held with a
pair of long pincers.
The conducting wire of the cathode is now connected with the
switch in the circuit of the current to be utilized and the conduct-
ing wire of the anode is connected with the potential reducer;
by means of the latter the operator manipulates the voltage, in-
creasing or diminishing it ; and the switch enables the operator to
open or close the circuit with facility.
As soon as apparent death takes place, with arrested blood pres-
sure and respiration^ synchronous or not, the operator opens the
animal's mouth so as to allow free access of air; this may be
continued during a period of from a few seconds to one minute ;
if there are no signs of returning life, the operator commences to
practice rhythmic electric excitations with the chosen current, say
a current of low tension and frequent interruption (from 6,000
to 12,000 per minute, period of the passage of the current i/io
of the entire time) .
The first rhythmic excitations are produced with the minimum
voltage necessary to cause maximum inspirations, generally from
15 to 20 volts.
An assistant keeps the animal's moxith open; the operator holds
the animal's tongue with one hand, by means of a tongue forceps,
and with the other he manipulates the switch.
The first closure of the circuit, lasting from %. to J/2, of a sec-
ond, causes an energetic artificial inspiration: the lifeless, flabby
tongue is contracted and drawn into the mouth, the anterior paws
are thrown upward and forward with great force (the animal is
on its back), the chest is markedly distended, the diaphragm is
pushed downward, the posterior paws are extended and all the
respiratory organs and muscles enter into play.
While these artificial phenomena of respiration take place, the
pendant les excitations rythmiques (Experience pratiquee sur le chien.
Application clinique). II. Anesthesie electriqne (Application clinique;
presentation de malades). III. Presentation d'instntments, Bulletin de
la society clinique de medecine mentale, November, 1908.
Since the presentation of this paper at the Societe clinique de medecine
mentale, Paris, November, 1908, we have constructed an mstrument giv-
ing from 25,000 to 30,000 interruptions per minute (see description of in-
struments in this issue).
158 THE JOURNAL OF MENTAL PATHOLOGY. Vol. "CiII, No. 4, 1909.
heart also reacts from the beginning — in the less grave cases ; but
in cases of profound syncope the heart does not react at once ; if
this is the case, the voltage should be increased without delay,
from 15 to 20 or 25 volts; the rhythmic interruptions of the cir-
cuit should continue while the voltage is being increased; the
rupture of the circuit should last from i to ij4, or 2 seconds,
according to the gravity of the case and the respiratory and
cardiac reactions.
The breaking of the circuit causes a marked artificial expira-
tion : the anterior paws extended in the air suddenly fall one on
each side of the animal's body while an expiratory chest movement
takes place; this fall of the paws is marked and causes a sort of a
double expiratory movement that is sometimes registered in the
traces that we have the honor of presenting to you to-day. The
tongue and all the other respiratory muscles are once more life-
less and flabby.
After the artificial expiration the animal's body remains inert,
flabby, without spontaneous respiration or cardiac beats. The
operator pulls the animal's tongue outward so as to allow free
access of air during the succeeding artificial inspiration.
The voltage is now increased, if necessary, and the circuit is
again closed as above, then opened, as indicated. If the heart
commences to beat artificially after a few rhythmic excitations
have been practiced, the same voltage is maintained as long as
the amplitude of the wave of the artificial blood pressure seems to
be satisfactory ; but as soon as this amplitude shows any decrease,
the potential is augmented to 30 volts, to 35, or even 40 volts, if
necessary; the rhythmic excitations are continued with this volt-
age, closely watching the amplitude of the respiratory curve and
that of the blood pressure; after a certain period of rhythmic
excitations, say from a few seconds to one minute, the artificial
cardiac reaction should become more and more vigorous ; if this
is not the case, the potential is increased to 50, 60 and 70 volts.
There should be a minimum delay in causing artificial cardiac
reaction; the artificial respiratory reaction is always obtained in
the beginning but the artificial respiration is useless without its
being accompanied by artificial heart beats. And the more the
artificial heart beat is vigorous, the more chance is there of spon-
taneous heart beat taking place. The spontaneous heart beat may
take place at any time during the rhythmic excitations — before
or after the onset of spontaneous respiration. After the excita-
tions have been practiced from 30 seconds to one or two minutes,
a feeble spontaneous respiratory movement takes place; the latter
RESUSCITATION.— Dr. Robinovitch. I5Q
may precede or follow the first feeble spontaneous blood pres-
sure, as you may see from the traces Nos. 3, 4 and 5.
In ordinary cases m which the syncope is not grave, the dog
may revive after the first spontaneous respiration — the spontane-
ous heart beats being re-established — without continuing the
rhythmic excitations ; but in the large majority of grave cases, it
is absolutely necessary to help the animal both in his respiration
and in his cardiac function — by alternating the feeble spontaneous
respiration and blood pressure with ample artificial respiration
and blood pressure until both functions are permanently re-
established.
It should be borne in mind that in chloroform poisoning, in
ether poisoning, in electrocution, in drowning, in hanging, etc.,
the blood is asphyxiated — dark; therefore, it is not sufficient to
cause feeble respiratory movements and feeble heart beats such
as are obtained with the Sylvestre and Laborde methods; it is
imperative to oxygenate the blood — by practicing ample artificial
respiratory movements — and by sending oxygenated blood into
the circulation by causing artificial heart beats — that propel oxy-
genated blood. The reason that surgeons often fail to revive
definitely patients in a condition of apparent death caused by
chloroform is as follows : the Sylvestre and Laborde methods gen-
erally used cause only feeble artificial respirations — with insuffi-
cient oxygenation of the blood ; even in cases of success, when the
heart beats are re-established, life is not permanently restored
because the bulbar respiratory and cardiac centers are definitely
asphyxiated through insufficient oxygenation.
An example of the alternation of feeble spontaneous blood pres-
sure and respiration with artificial ample blood pressure and res-
piration is registered in trace No. 5.
The artificial blood pressure and respirations should never en-
croach on the spontaneous blood pressure and respiration, espe-
cially when the latter are feeble; the operator risks causing in-
stantly the animal's death by such an encroachment. We have
had several cases of this kind. The blood is asphyxiated, dark,
in dogs in a condition of chloroform syncope; for this reason, in
cases of grave syncope, artificial respiration alone is useless with-
out being accompanied by blood pressure. On the other hand,
artificial respirations obtained with Sylvestre's method or by
means of rhythmic traction of the tongue never present the
amplitude of those caused by electric currents.
In one case of grave cardiac syncope we have tried a method
of resuscitation in imitation of that generally applied in surgical
emergencies ; that is to say, instead of causing, by means of elec-
l6o THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, 1909.
trie currents, artificial ample respiratory movements and heart
beats, as may be practiced by using gradually increasing voltage,
we limited ourselves to the use of a small potential of 8 volts
during the entire period of the respiratory and cardiac syncope.
The result of this experiment is registered in trace No. i.
The experiment registered in trace No. i was performed on a
dog. After a certain period of chloroforming the blood pressure
(registered by Frangois-Franck's manometer, simple type) was
between i6 and 17 centimeters of mercury, and the respirations,
after a period of marked irregularity, became rapid and frequent.
Then, in the course of 5 seconds, there was an abrupt fall of the
blood pressure in the carotid artery, — down to the absciss. Arrest
of the heart beat preceded that of the respiration. The cardiac
paralysis was followed by a grave disturbance of respiration : the
amplitude of the respiratory curves was abruptly decreased, then
became small — almosi imperceptible — and then there was a defi-
nite arrest of respiration, as you may see from the registration in
the trace.
The rhythmic excitations were begun about 40 seconds after
the last registered cardiac contraction and 15 seconds 3iitv the
arrest of respiration.
The rhythmic excitations were practiced in imitation of the
method used in rhythmic traction of the tongue, rhythmic con-
traction of the chest, Sylvestre's method, etc. ; that is to say, small
rhythmic respirations were caused to take place by means of an
electric current of 8 volts (current of frequent interruption, period
i/io) ; the excitations were made every % or ^ second, repeated
every i to 3 seconds.
These respirations of minimal amplitude were not followed
immediately by spontaneous respiration, nor was there artificial
or spontaneous blood pressure; there was no sign of any heart
action during a period of two minutes ; this period is indicated by
a straight line in the trace. After this period the heart began to
beat spontaneously, but spontaneous respiration did not reappear.
The amplitude of the cardiac curves increased gradually and
there seemed to be hope of resuscitation : the artificial respirations
were too feeble to allow useful oxygenation of the blood to take
place. The animal died, then, as one dies from ordinary asphyxia-
tion— from arrest of respiration followed by arrest of the heart
beats.
The animal could have been resuscitated with the method that
we have the honor of presenting to you to-day ; with our method
we can not only regulate the amplitude of the respiratory curve
'V^^irMll'Dflfl/^IVir-'^Vj'ilVijr
I ^^ ^
The Journal of Mental Pathology, Vol. VIII, No. i, 1909.
Illustrating Dr. Robinovitch's Paper.
UHHHj-UAj--^ -J-u-l^^.^u-,j-iM}ill^i!J-<J^j'LMJ-iMj4MU
Trace No. 2. — S, cardiac syncope; E, rhythmic excitations with an induction current; voltage ireased gradually from 10 to o of the scale (Dubois-Reymond apparatus, coil
No. 2) ; R, first spontaneous respiration. ■
RESUSCITATION.— Dr. Robinovitch. i5x
but artificial heart beats may also be caused to take place, — as you
may see in traces Nos. 2, 3, 4 and 5.
Indeed, in trace No. 2, of December 7, 1907, is registered the
experiment performed on a dog, weighing 12 kilograms ; apparent
death was caused by excessive chloroforming. Cardiac syncope
preceded respiratory syncope and was quite as grave in nature as
was that registered in trace No. i. Cardiac syncope set in gradu-
ally, then there was complete cardiac paralysis that lasted 52 sec-
onds, as is indicated in the trace.
The rhythmic excitations were begun after fall of blood pres-
sure and complete cardiac arrest; the electric current used was
an induction current, Dubois-Reymond's apparatus, coil No. 2
(medium between i and 3). As the cardiac syncope was of a
grave nature, we tried to obtain — first artificial then spontaneous
cardiac beats — as well as spontaneous respiration — with as little
delay as possible. With this end in view economy of time was of
utmost importance; therefore, the potential was increased pro-
gressively but rapidly by displacing the coil from 10 to o centi-
meters of the scale while the rhythmic excitations were being
produced.
Cardiac beats commenced 52 seconds after the first rhythmic
excitation and the first spontaneous respiration took place after
the excitations had been practiced for 3 minutes and 20 seconds.
The animal was resuscitated.
The same animal was chloroformed three times in the same
afternoon, and every time was put in a condition of apparent
death ; and every time resuscitation was complete.
The study of traces Nos. i and 2 is convincing in favor of our
method of resuscitation.
In trace No. 3, of November, 1907, is registered an experiment
on sudden respiratory syncope caused by intensive chloroforming
in a dog weighing 19 kilograms. The amplitude of the respiratory
wave immediately preceding the respiratory syncope is satisfac-
tory, and therefore the onset of the syncope is unexpected. The
syncope lasted 57 seconds before the rhythmic excitations had
been commenced. These excitations were caused with an elec-
tric current of 24 volts, 6,000 interruptions per minute, period
i/io. Each ample artificial respiration is accompanied by an ac-
centuated cardiac beat.
Blood pressure was maintained during the entire period of
respiratory syncope, but the syncope was of a grave nature —
because it was necessary to practice artificial respiration during
a period of one minute before spontaneous respiration set in.
Resuscitation was complete; the animal was submitted a second
I62 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, lit09.
time to chloroform syncope; this syncope lasted one minute, and
the second resuscitation was also complete.
The gravest cases of chloroform syncope are those in which
the amplitude of the respiratory wave and the blood pressure —
immediately preceding the onset of syncope — is normal or even
more marked than normal: the sudden onset of vSyncope takes
place without any warning. From the surgical standpoint, such
cases are the most difficult ones to handle, — because of the unex-
pectedness of the accident; and the ordinary means of resuscita-
tion at the surgeon's disposal are useless. It is in these cases
particularly that the electric method of resuscitation is of the
utmost utility. Such a case is regisered in trace No. 4. The
experiment was performed on a shepherd dog (female), weighing
14 kilograms.
The curve of the respiratory movements and of blood pressure
in the carotid artery was in perfect proportion, when suddenly,
without any warning, respiratory and cardiac syncope set in syn-
chronously, as you may see in trace No. 4. We waited twenty
seconds but there was no sign of life in the animal; rhythmic
excitations were then practiced with an electric current of 20
volts (6,000 to 12,000 interruptions, period i/io).
In this trace you can easily see the registered artificial blood
pressure^ — following each artificial respiration — caused by the
rhythmic excitations. After a certain length of time, and while
the excitations are still being practiced, a spontaneous element
appears in the blood pressure, as you may see in the trace before
you. The first spontaneous respiration appeared after a period
of rhythmic excitations that lasted two minutes and 48 seconds,
the current used was as explained — 20 volts. The syncope was
of grave nature, and it was with great difficulty that we succeeded
in resuscitating the animal. The minimal amplitude of the spon-
taneous respirations indicates the gravity of the syncope that
preceded.
After the experiment we tied the right carotid artery preparing
to close the wound and to put the animal on its paws again. By
accident, the carotid artery was severed at the cardiac end — be-
yond the ligature, and the profuse hemorrhage that followed made
it impossible for us to find the cardiac end of the artery that had
receded behind the clavicle (the connective tissue around the
artery had previously been thoroughly dissected for a special pur-
pose and the artery was disconnected from the pneumogastric
nerve down to the clavicle). The animal bled until apparent
death set in — there being neither respiration nor blood pressure:
the animal lay lifeless, the bleeding had ceased completely and the
The Journal of Mental Pathology, Vol. VIII, No. 4, 1909.
Illustrating Dr. Robinovitch's Paper.
Trace No. 3.— Respiratory syncope. S, commencement of the syncope; E, commencement of rhythmic excitations; R, commencement of spontaneous respirations.
RESUSCITATION.— Dr. Robinovitch. 163
gums, tongue and conjunctiva were bloodless. We now had no
difficulty in finding the severed end of the artery by following the
course of the pneumogastric nerve down to the clavicle. The
artery was now tied and the animal remained in a condition of
apparent death — without respiration or cardiac beats. We had no
hope of saving the animal, but a sheer experimental whim made
us try to revive the dog; we supposed for a moment that the ani-
mal represented one of our patients, who, often enough are
brought in with severed vessels in their necks — self inflicted
during an attempt at suicide. With this thought in mind and
without any hope of success we commenced to practice rhythmic
excitations as we had previously done on the same animal. To
our great surprise the animal showed a very feeble spontaneous
inspiration. We continued the rhythmic excitations: there was
no sign of any blood pressure (cardiac beats), the pauses between
the minimal spontaneous respirations were long, and death seemed
to be imminent. But we kept up the practice of the rhythmic ex-
citations, and to our great surprise resuscitation was complete
after a period of 5 minutes since the first spontaneous respiration
took place.
This is the first experiment, we think, in which resuscitation
was practiced by means of our method in a case of grave hemor-
rhage from a vital artery.
During the week following this accident, the animal was in a
deplorable physical condition, and death seemed to be imminent
at any time ; nevertheless, the great care and milk diet enabled the
animal to get stronger, although we did not make any injection
of serum or blood. August 14, 1908, the dog was sufficiently
recovered to be subjected to a second experiment on chloroform
syncope. Trace No. 5 presents this second experiment, and is
most mstructive from, the standpoint of resuscitation. The blood
pressure was taken in the left femoral artery, with Marey's mano-
meter.
There are certain points of importance in this experiment and
they are cited below :
1. Cardiac syncope preceding respiratory syncope.
2. Alternation of artificial and spontaneous respirations.
3. Artificial cardiac reaction following each artificial respira-
tion.
4. Second respiratory syncope — after resuscitation. Rhythmic
excitations resumed and second resuscitation established.
5. Comparative efifect of excitation with the cathode in thoracic
and in the precordial region respectively.
Necessity — after the second respiratory syncope — of augment-
l64 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, 1909.
ing the voltage rapidly and repeatedly until resuscitation is
obtained.
The above combination of unusual circumstances during chlo-
roform syncope is rare and most interesting as well as instructive.
The cardiac syncope lasted 20 seconds before the rhythmic
excitations had been commenced (20 volts, current interrupted
6,000 to 12,000 times per m.inute, period i/io). Three excitations
were made with this voltage, but the cardiac reaction was too
feeble ; there was a pause while the voltage was being augmented,
and the heart was at a stand-still during that pause; excitations
were now made with 30 volts; this voltage caused good respira-
tory movements as well as ample artificial cardiac reaction. But
as soon as the artificial respiration was stopped, the cardiac reac-
tion was also abolished. The excitations were continued during
a period of i minute and 49 seconds; at the end of this time a
spontaneous respiration took place and was repeated four times;
the cardiac reaction also showed a spontaneous element; the
rhythmic «jsutations were stopped, and the spontaneous respira-
tion also stopped for the second time. The excitations were. re-
sumed with 30 volts, and continued with 50, then 58 volts during
a period of 10 seconds; spontaneous respiration reappeared but
its amplitude was small ; then, without delay, the small spontane-
ous respirations are alternated with ample artificial respirations ;
spontaneous respiration was then definitely re-established; the
wound was closed and the animal put on its paws again. In two
weeks the dog was completely recovered. And to-day, November
25, 1908, the animal is in perfect physical condition and we pre-
sent it to you for inspection.
In this experiment the reactions obta^r^d with the cathode on
the precordial region were inferior to those obtained with the
cathode applied at the dorsal region; anatomically and physio-
logically— the fact should be as it is.
Our five traces show that the term "chloroform syncope" is a
vague expression, because there are not two cases of this syncope
that are alike even in the same animal.
And the comparison of the ordinary methods of resuscitation
with our method shows the advantage that our method presents.
In one of our works that is being prepared for publication we
reproduce on a larger scale the traces relating to the study in
question and also cases of chloroform syncope that had lasted
from 4 to 5 minutes and in which resuscitation was complete in
spite of this long duration.
The application of our method is easy and practical : before a
surgical operation is begun the two electrodes should be placed
\
Thb Jouskal or Mental Pathology, Vol. \ III, No. 4, 1909.
lUustratiiu: Dr. Robinovitch's Paoer.
B
D
R
Q
u
XXX
Trace No. 5. — Cardiac syncope precding respiratory syncope. C, cardiac syncope; A, first rhythmic excitations with 20 volts (direct current interrupted 6 to 12,000 times per
minute, period i/io) ; B, excitations with 30 volts ; C excitations with 40 volts; D, rhythmic excitations with 50 volts; E, rhythmic excitations with 58 volts; R, first four spontaneous
respirations ; S, second respiratory syncope; Q, rhythmic excitations with 50 to 58 volts, the cathode being applied over the precordial region; U, a spontaneous respiration; V.
rhythmic excitations with same voltage, but cathode in the dorsal region ; XXX, spontaneous respirations followed by resuscitation.
surg-icai uperanun is oegnn me two eieciroaes snouia De piaceci
X
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G O 3
.2 CO o
as o S
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RESUSCITATION.— Dr. Robinovitch. i6s
*
under the patient, in their respective regions, the conducting wires
adjusted and the electric source should be ready for use in cabe
of syncope caused by chloroforming.
The preferred current is the one of low tension and frequent
interruption; our second choice is an induction current of suffi-
cient voltage and intensity, obtained with our model of coil made
for this purpose.
The wire of this coil should have a diameter not under 6/10
mm. ; it is dangerous to use wire of smaller diameter. For details
of the construction of the apparatus see our paper entitled '*An
Induction Coil Specially Constructed for Resuscitation of Sub-
jects in a Condition of Syncope Caused by Chloroform."
It is of the utmost importance to exclude the animal's or the
patient's head from the circuit during the rhythmic excitations.
We have indicated elsewhere (3), and we repeat, that among
others, the cerebral and bulbar blood vessels contract at every
closure of the circuit. This special condition is unfavorable for
the re-establishment of function of the respiratory and cardiac
centers in the medulla oblongata; therefore, exclude the head
from the circuit.
It is important to employ the minimal voltage possible for the
production of the most ample respiratory and cardiac reactions.
The current may vary between 10 and 70 volts, for dogs without
reference to size. With higher voltage we have never succeedec
in resuscitating dogs.
In normal man we have obtained good respiratory reaction with
a current of low tension and frequent interruption — using 20 to
90 volts. The amperage cannot be measured in these cases on
account of the rapid closure and opening of the circuit.
For human beings we use electrodes measuring 25 by 30 cts. for
the dorsal region and 12 by 25 cts. for the lumbar region.
Various electric currents may be used (4) : the alternating (the
worst and its use should be avoided), continuous, induction cur-
rent and the current of low tension and frequent interruption;
the current of high frequency has given us negative results. We
insist on the danger of using the alternating current that is fatal
3. Dr. Louise G. Robinovitch. — Methods of Resuscitating Electrocuted
Animals. Different Effects of Various Electric Currents According to
Method Used. Importance of Excluding from the Circuit the Central
Nervous System During Resuscitation, The Journal of Mental Pathol-
ogy, Vol. VIII, No. 3, 1907.
4. Dr. Robinovitch. — Methods of Resuscitating Electrocated Animals.
Different Effects of Various Electric Currents According to Method
Used. Importance of Excluding from the Circuit the Central Nervous
System During Resuscitation, also: Different Effects of Various Elec-
tric Currents (in this issue).
l66 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, 190«.
to cellular life. The continuous current may be used, but it is
better to substitute for it a current less dangerous to cellular life.
The induction current furnished by a large coil made specially
according to our indications for this purpose gives satisfactory
results. Our preferred current is the one of low tension and fre-
quent interruption (5).
The application of the cathode in the thoracic (dorsal) region
gives better results than in the precordial region.
Our method can be used for resuscitating drowned subjects,
subjects in a condition of apparent death caused by angina pec-
toris (non-obstructive), etc. Our method is especially applicable
in cases of apparent death caused by electrocution. Our method
of resuscitating subjects in chloroform syncope is the result of.
our researches into resuscitation of electrocuted subjects (6).
What we have indicated for the former applies equally to the
latter.
The first physiologic researches into the mode of death by elec-
trocution and into the mode of resuscitation were made by Pro-
fessor Batteli ; an abstract of his paper is published under the
title of "Fulguration" in Richet's Dictionary of Physiology, 1900.
Resuscitation is attempted with a single shock of 4,800 volts of an
alternating current — during a fraction of a second. This excita-
tion must be made before the fall of the blood pressure to the
absciss ; unfortunately the author does not succeed in resuscitating
his subjects when applying such severe shocks after the descent
of the blood pressure to the absciss; his results are often fatal
even when the shock is applied before the arrest of blood pres-
sure. This fact is easily explained, because this mode of resus-
citation is not only dangerous for the subject electrocuted, but it
also is a hazardous means ; resuscitation must take place with one
or at the utmost with two excitations with this high voltage; in
case of failure, repetition of such excitations would be fatal to
life.
If Dr. Battelli's method is not useful from the practical point
of view, his studies are interesting from the physiologic point
of view as first experiments.
5. Since the presentation of this paper, in November, 1908, we have
constructed a new instrument for frequent interruptions — from 25,000 to
30,000 per minute (see description of instruments in this issue).
6. Dr. Louise G. Robinovitch.-^Methods of Resuscitating Electrocuted
Animals. Different Effects of Various Electric Currents According to
Method Used. Importance of Excluding from the Circuit the Central
Nervous System During Resuscitation, The Journal of Mental Pathol-
ogy, Vol. VIII, No. 3, 1907.
RESUSCITATION.— Dr. Robinovitch. 167
The eminent physiologist of Nantes, France, Professor Roux-
eau, followed up the question with his valuable physiologic studies
of the mode of death and of resuscitation in electrocution ; he pub-
lished his researches jointly with Prof. Leduc (7) ; their method
of resuscitation is more practical : the cathode is applied to the
forehead and the anode to the abdomen ; the rhythmic excitations
are made with the lethal current, and, besides, the current used is
favorable (current of low tension and frequent interruption,
period i/io). This method gives good results in rabbits, but not
in dogs (8) . We were the first to find the means of practical value
by which electrocuted dogs may be resuscitated (the dog's heart is
highly sensitive and its vitality is easily killed with electrc cur-
rents). We were the first to show the necessity of excluding
from the circuit the animal's head during the rhythmic excita-
tions; we were also the first to show the necessity of using the
minimal possible voltage for causing the maximum possible res-
piratory and cardiac reactions immediately following apparent
death, and of increasing the voltage progressively with the con-
tinuation of the resuscitation : apparent death may continue for a
period of some minutes, and we have been the first to point out
the danger of exhausting the cardiac excitability in the beginning
of the rhythmic excitations — by using high voltage to produce
them.
It is important to bear in mind that electrocution caused with
any current, — continuous, alternating, induction or that of low
tension and frequent interruption, — produces asphyxia and car-
diac paralysis. A few seconds after the passage of the lethal cur-
rent the blood becomes asphyxiated and it appears dark in the
large vessels where it can be seen. This asphyxia of the blood
persists a long time after resuscitation. Thus, we electrocuted a
shepherd dog and we resuscitated it. An hour after we subjected
the animal to an experiment necessitating opening of the carotid
artery; while doing so, the arterial blood appeared dark — venous
— asphyxiated.
From the practical point of view, our method is especially appli-
cable in man in cases of accidental electrocution, particularly in
electric power houses where connection with current can easily be
7. MM. Leduc and Rouxeau. — L'inhibition respiratoires par les cou-
rants intermittents de basse tension: Societe de Biologie, July 4, 1903.
8. Dr. Louise G. Robinovitch. — Methods of Resuscitating Electrocuted
Animals, etc. ; General and Cerebral Blood Pressure During an Attack of
Electric Epilepsy, etc. ; Methods of Resuscitating Animals in a . Condition
of Respiratory and Cardiac Syncope Caused by Chloroform, etc. The
Journal of Mental Pathology, Vol. VIII, No. 3,, 1907.
l68 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, 1909.
made. In case of accidental electrocution, the cathode should be
applied on the back — ^the upper border reaching just below the
root of the neck ; and the anode over the lumbar region ; rhythmic
excitations should then be made with the lowest possible potential
that will cause good respiratory and cardiac reaction ; this should
be continued until ample spontaneous cardiac and respiratory
movements are established.
In accidental electrocutions death is seldom immediate ; contact
with the live wire is generally made by touching it with the hand
or the foot; consequently, the electric shock is seldom as marked
as it is in cases of laboratory electrocutions. In the majority of
cases of accidental electrocution the patient continues to breathe
for a period of from a few minutes to one-half hour after the acci-
dent,— when death takes place by respiratory and cardiac paraly-
sis. Therefore, there is the utmost necessity that the physician
practice on his patient artificial respirations and cardiac beat-s
immediately and not allow death to set in while the patient's
respiratory and cardiac centers are being gradually but surely
asphyxiated.
For emergency in power houses or in any place where an acci-
dental electrocution may take place, we have constructed a special
coil that gives a sufficiently strong current for practicing rhythmic
excitations. The diameter of the wire of this coil should net be
below 6/10 mm. Where it is practicable to do so, the use of the
current of low tension and frequent interruption is much to be
preferred (9).
Application in Man. — We were the first to apply in man
rhythmic excitations caused with the current of low tension and
frequent interruption. Our patient, a man, chronic alcoholist, was
under our treatment for hemianesthesia of many years' duration ;
he had been an inmate at the Ste.-Anne Asylum, Paris, at various
times during the last twenty years. In this patient we obtained
excellent respiratory reactions with the current of low tension
and frequent interruption, using 20 to 90 volts. These shocks were
not painful ; on the contrary, the patient was amused by the rhyth-
mic and involuntary reactions.
There is every indication for the use of electric currents in cases
of apparent death. Indeed, we have had occasion to make such
9. Since the presentation of this paper at the Societe clinique de Mede-
cine Mentale, Paris, November, 1908, we have constructed a new instru-
ment for frequent interruptions of the continuous current, giving from
25,000 to 30,000 interruptions per minute (see description of the instru-
ment in this issue).
ELECTRIC ANESTHESIA.— Dr. Robinovitch. 169
use of an induction current in man with happy results; we shall
relate the case elsewhere.
The cathode should always be at the dorsal and the anode at
the lumbar region.
We have two terminals in our electrodes ; the conducting wire
is bifurcated, and each branch of the wire is screwed into the cor-
responding terminal of the electrode. This is done as a matter
of precaution: for unaccountable reasons, it often happens that
the conducting wire is unscrewed and separated from the electrode
during the operation. In case of apparent death in man, an acci-
dental delay of this kind is avoided by using a bifurcated con-
ducting wire. We have never had both ends of the wire accident-
ally disconnected from the electrode.
ELECTRIC ANESTHESIA IN LABORATORY SUR-
GERY SUCCESSFULLY APPLIED DURING
A PERIOD OF THREE YEARS. DEM-
ONSTRATION ON AN ANIMAL, AND
CLINICAL APPLICATION (Pres-
entation of patients).
(From Dr. Magnans Laboratory, Ste.-Anne Asylum, Paris,
Directed by Dr. Louise G. Robinovitch.)
By Louise G. Robinovitch, B. es L., M.D.,
Paris; Member, New York Academy of Medicine; Member,
American Medical Association; Foreign Associate Member,
Medico-Psychological Society, Paris.
In 1906 we were the first to apply electric anesthesia in labora-
tory surgery ( i ) ; we have continued up to date the substitution
of electric anesthesia for chloroform and ether anesthesia in all
I. Dr. Louise G. Robinovitch. — Electric Sleep. An Experimental Study
of an Electric Current of Low Tension. Illustrated with Cardiac and
Respiratory Tracings. A Preliminary Communication. The Journal of
Mental Pathology, Vol. VII, No. 4, 1905.
IjQ THE JOURNAL OF MENTAL PATHOLOGY. Vol. VUL No. 4, 10C9.
our laboratory surgery. The method of appHcation and the inter-
rupter described in our thesis (2) and in other papers has since
been modified by us. The most important modification lies in the
construction of the interrupter through which the electric current
passes. We have been obliged to change every detail in the in-
strument directly connected with the interruption of the current
in order to insure safety in the application of this form of anes-
thesia. The instrument is described in another paper entitled
Motor-Interrupter Supplying a Current of Frequent Interruption
for Electric Anesthesia (3).
We have also increased the number of interruptions from
6,000 to 12,000 per minute; we use preferably 8,000 interruptions
per minute ; the course is maintained as even as possible, by means
of a rheostat in the circuit ; and the two contacts at the commuta-
tor we have rendered as flexible as possible, so as to do away with
sudden jars while the anim.al is in the circuit. All our modifica-
tions have been made step by step, as we noted the imperfections
of the electric anesthesia obtained with the old interrupter first
constructed by Profs. Leduc and Rouxeau.
We still find i/io period convenient with 8,000 interruptions
per minute. The cathode is applied at the head and the anode at
the lumbar regionl The electrodes are made of zinc, covered or
not with chamois, but always covered with a thick layer of ab-
sorbent cotton wet with a salt solution 7 per 1,000. The cathode
/bould be large enough to cover the forehead.
The continuous current is interrupted at the negative pole ;- and
we repeat that the cathode should be at the head (see our thesis
cited above, pp. 34 to 39, on the danger of applying the anode at
the head).
The circuit is closed at 0 volts ; the voltage is then gradually
increased by manipulating the handle of the potential reducer;
2. Electric Anesthesia or Electric Sleep : Reference Handbook of Med-
ical Sciences, Wm. Wood and Co., 1907.
Electric Anesthesia in Laboratory Work, The Journal of Mental Pa-
thology, Vol. VIII, No. 3, 1907.
micsihesie electrique (application clinique; presentation de malades),
Bulletin de la societe clinique de medecine mentale, November, 1908.
Sommeil electrique, epilepsie electrique et electrocution. These de
Paris, 1906.
3. Since the presentation of this paper at the Paris Societe clinique de
medecine mentale, November, 1908, we have constructed a new instru-
ment, with which more rapid interruptions are obtained — from 25,000 to
30,000 per minute. The cost of this new instrument is considerably below
that of the instrument described (see description of our new instrument
in this issue).
ELECTRIC ANESTHESIA.— Dr. Robinovitch. 171
while doing this the operator pays particular attention to the
voltage and amperage. A dog can be anesthetized with from
5 to 10 volts, the milliamperage ranging between 1.5 to 2 mA.
The resistance of a dog is between 300 and 500 ohms, according
to the animal and — the size of the electrodes used.
At the beginning of the passage of the current the animal is
uneasy; as the current is being increased the anirnal becomes
agitated and tries to free itself; the current is then increased a bit
more and electric anesthesia follows instantly; the animal falls
on its side and remains quiet. If the anesthesia is kept up for a
long time, it is necessary to gradually decrease the voltage — the
smallest fraction of a volt at a time; during such anesthesia the
animal keeps its eyes wide open and is apt to lift its head at
various intervals, for a second or two; the animal may even
make an effort to raise itself, but immediately falls back on its
side and remains quiet again. Consciousness is not completely
abolished.
The eyes are always open during electric anesthesia, the cuta-
neous reflexes are considerably exaggerated ; the sense of touch is
blunted but not abolished. Sensibility to pain is markedly reduced
but not completely abolished. Regardless of this, the dog, of
all animals used in laboratory work the most sensitive to pain,
stands well the most painful operations under this anesthetic,
such as exposing the carotid artery, the femoral artery, trephining
of the skull, abdominal operations, etc. In our experience extend-
ing over a period of three years, we have not had any untoward
accident attributable to this anesthesia. Immediately after the
operation the animal walks about and shows no after effects, as
you may see from the actions of the animal on which I have
operated before you.
It should be borne in mind that electric anesthesia causes abor-
tion in pregnant animals ; the abortion may take place on the same
day or the day following the electrization. If the animal has
milk in its breasts, the milk is projected with force at tiie begin-
ning of the electrization.
At the beginning of the anesthesia there is evacuation of the
bowels and of the bladder.
We repeat the caution we have presented in our paper on elec-
tric anesthesia, published in the Reference Handbook of Medical
Sciences, Wood & Co., 1907: No physician should undertake to
practice electric anesthesia on man without having had two years*
daily experience in this work. It is not difficult to practice the
anesthesia; on the contrary, everything connected with it is as
simple as can be. But the proper manipulation of the voltage and
amperage together with the correct understanding of the respira-
172 THE JOURNAL OF MENTAL PATHOLOGY. Vol. \ III, No. 4, 1909.
tion and pulse of the subject in the circuit may be expected of
none but of the physician who has had at least two years' daily
experience in the work.
We feel a great responsibility in presenting the good results
obtained in our work and for the following reason: an excellent
colleague, a thorough electrician and surgeon became enthu>?d
with our work, repeated our experim.ents a few times, and con-
sidered himself sufficiently prepared to demonstrate the operation
to a large gathering of professional men at one of the leading
universities in Europe. The animal chosen was a rabbit; it was
put into the circuit, the voltage turned on, and — electrocution —
instead of anesthesia was the result.
Such a result seems incomprehensible to us, for we have pre-
sented in our thesis and in all our papers on this subject the pos-
sible dangers that should be avoided. Yet the animal was elec-
trocuted— when it was most desired only to anesthetise it. Tht
potential used — by mistake — was some 70 volts — instead of 5 to
8 volts. In case of a man the mishap would have been most
serious. Had our colleague been familiar with the normal respira-
tion and pulse of a rabbit in the circuit of a current intended for
anesthesia, he would have recognized his mistake at once; he
would have turned off the current immediately, and no harm
would have been done, except for a momentary electric shock
with some 70 volts — that is never of any importance — if it lasts
only a second or two. But such a current is dangerous if lefx
to course through a living animal indefinitely. We have repeat-
edly demonstrated the impossibility, — in our hands, — of even
shocking an animal during electric anesthesia; with the animal
in the circuit, we have shown repeatedly that after the anesthetic
dose has been reached, with 5 or 10 volts, the slightest increase of
this dose, — even to the extent of a fraction of a volt, excites the
animal; the experienced operator utilizes this peculiarity as a
guide in the increase or decrease of the potential. The only way
in which an operator can succeed in killing an animal during elec-
tric anesthesia, is for him to disregard the animal's agitation
while he increases the voltage, then to disregard the animal's con-
vulsions as he still continues to increase the voltage twice, five and
ten times the normal dose, — until electrocution takes place. Such
a thing seems preposterous, and yet it has been done by an excel-
lent electrician and surgeon — before a learned audience. It is not
superfluous, therefore, for us to repeat, that no physician should
attempt to practice this anesthesia on man, unless this physician
has had two years' daily experience in this work on animals.
To avoid all possible accidental shock, the physician should
ELECTRIC ANESTHESIA.— Dr. Robinovitch. 173
know that the voltage and amperage necessary to induce anesthe-
sia is quite Hmited in range; the resistance of man and dog, —
when electrodes of dimensions indicated by us are used, — is about
300 ohms. In dogs, — from 5 to 10 volts, showing from 1.5 to 2
milliamperes, cause anesthesia. The resistance varies in animals ;
but it does not vary so much that it should become necessary to
use a current strong enough to electrocute the subject. Electro-
cution, in these circumstances, is the result of some grave mis-
take ; a man who commits such a mistake on animals should put
in two years in daily practice of this work, before attempting such
anesthesia on man.
One more word of caution: before attempting the practice of
electric anesthesia on man, the physician should be thoroughly
familiar with our method of resuscitation. In the hands of a
practiced operator an accidental electrocution (although unpar-
donable) as is the one related, is of no importance, because a
slight shock of short duration is not dangerous if resuscitation is
immediately attempted. We have experimentally repeated our
colleague's mishap — shocking the animal to death — as he had
done accidentally, and bringing it back to life — as he had not
done. We have never lost an animal in this series of experiments.
While urging the necessity of caution, we have no hesitation in
recommending electric anesthesia as an excellent substitute for
ether and chloroform.
Contra-Indication. — Centrally, electric anesthesia should not
be applied in the old, in subjects affected with arterio-sclerosis or
in patients subject tO' epileptic, apoplectiform or apoplectic at-
tacks. The effect of the current is to heighten the blood pressure
(see our thesis cited above.)
The duration of electric anesthesia may be prolonged for many
hours without any danger to the patient. In our thesis already
cited we present an experiment in which an animal was kept
under the influence of this anesthesia for a period of eight hours
and twenty minutes. The temperature and respiration remained
normal during the whole period (see pp. 32-33).
Central anesthesia in man may be produced with from 37 to
40 or more volts of the current described. In the hands of a
practiced physiologist thoroughly familiar with the respiration
and blood pressure of the subject in the circuit there is perfect
safety in the operation.
Local Anesthesia. — In 1906 we practiced local anesthesia on
our own arm, using 25 volts ; the amperage was not recorded,
but it is generally between 1.5 and 4 milliamperes. The experi-
ment is now repeated before you on our distinguished colleague's
174 '^^^ JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4. 1909.
forearm. Both the cathode and the anode should be appUed
along the sensory nerve. We are using now 25 to 30 volts. Con-
traction of the muscles is avoided by keeping the electrodes off
the muscles. A special electrode should be made for this purpose.
We prick our colleague's forearm with a pin, stick the pin into
the skin until blood is drawn. Our colleague does not feel the
sharp pain, but his sensibility to pain is not absolutely abolished.
His forearm in the circuit feels as if it were "asleep" ; the sensa-
tion of pain is deadened, distant and he does not make any de-
fensive movement when you stick the pin through the skin, as
you see.
Importance of Appropriate Electric Sources for Causing
Electric Anesthesia. — We have indicated in our previous pub-
lications the importance of using appropriate electric sources
for electric anesthesia. In the papers published by Professors
Leduc and Rouxeau it is simply stated that a continuous city
current was necessary, etc. And in our first papers on the sub-
ject of electric sleep which we had prepared in the laboratories of
Professors Leduc and Rouxeau, we repeated with them tnat the
city current was the proper one to use for electric anesthesia. JBut
since 1905 our personal experience has taught us that it is dan-
gerous to use the city current. While we were in Rome, Italy,
in 1905, we were scheduled to present our experiments on
electric sleep before the International Congress of Psychology.
The city current in Rome is not a direct but an alternating cur-
/ent, so that it became necessary to use storage batteries. The
electric anesthesia obtained with this current was far superior to
that obtained in France with the city current. At first it was our
impression that the Roman rabbit was more susceptible to this
anesthesia than were the French rabbits; we wrote to the Pro-
fessors above named that this was our impression. But on re-
turning to their laboratories, in France, we resumed our work
with the city current: the electric anesthesia was inferior to
that obtained by us in Rome with a current from a storage
battery. We then used a current from storage batteries and
it was a great swrprise to see a quieter and more marked an-
esthesia follow than was that obtained with the city current.
It was now evident that the cause of superiority was due not to
racial traits of the respective rabbits but to the difference between
the two currents. The matter was now a simple one : the current
obtained from a storage battery that is used for no other purpose
is far more even than is a city current; the latter is always dis-
turbed by running dynamos or lighting of lamps. The storage
ELECTRIC ANESTHESIA.— Dr. Robinovitch. 175
battery current is like a smooth, quiet lake ; while the city current
is like a turbulent sea — for the purpose of electric anesthesia.
We have established the fact, therefore, that accumulators-
should be used for the supply of the continuous current.
And now, in this laboratory, that we have organized and have
the honor of directing, we have installed a series of powerful
storage batteries ; we have here 126 volts from batteries of
marked capacity, 200 amperes. We have installed this powerful
current for various other experiments ; but at the same time, we
obtain as perfect electric anesthesia as can be obtained to-day.
We draw on no volts of these batteries ; the rest of the current
is used for the motor. Of the no volts of these batteries we
use not more than from 5 to 10 volts, of minimal amperage, —
from 1.5 to 2 milliamperes. According to the knowledge of pro-
fessional electricians, it is wasteful to use such powerful bat-
teries for such a minimal requirement. But according to our
daily experiences in electric anesthesia the results obtained under
these conditions are perfect. Physiology apparently does not
lend itself to calculation by formula. According to this expe-
rience, it is well to use powerful batteries ; in hospital work it is
particularly important to obtain as perfect electric anesthesia as
is possible to obtain, and large batteries should be used. Another
advantage of having such batteries is that the current of no
volts may be utilized for purposes of resuscitation of subjects in
a condition of apparent death caused by various intoxications, or
accidents.
We have installed here various electric currents for various
experimental purposes ; but it goes without saying that for elec-
tric anesthesia none but the current from storage batteries should
be used; it is dangerous to use the direct city current; it is out
of question to use a direct current transformed from an alternat-
ing current; this should never be done; currents from ordinary-
wet batteries should never be used, because the chemical decom-
position goes on rapidly and the current is most uneven.
Technique and Instrumentation. — The instruments should
be arranged as follows below :
The positive and negative poles of the current are connected
with the respective terminals of a potential reducer, the lever of
the reducer being at zero. The outlet terminal of the negative
pole is connected with a wire, leading the current into the inter-
rupter; from the interrupter the current is led into a milliam-
peremeter, into an ordinary switch and finally into a resistance
box. The positive pole is led directly from the potential reducer
176 THE JOURNAL OF MENTAL PATHOLOGY. Vol. V 111, No. 4, 1909.
to the resistance box : The resistance box represents the patient
or the animal. A voltmeter is connected with the potential re-
ducer in derivation, of course.
Regulating the Period. — You begin the operation by regu-
lating the period of the passage of the current. The circuit is
closed by means of the switch. A chosen resistance is put in the
circuit by means of the resistance box. The current is thrown
into the circuit by means of the potential reducer — slowly, grad-
ually. The voltmeter indicates the number of volts used, and the
milliamperemeter indicates the number of milliamperes. Suppose
there are 40 volts and 20 miUiamperes, the current being unin-
terrupted, of course. (The wheel of the interrupter is placed so
that the current can get through it.) Now, the motor of the in-
terrupter is put into action and the current is being interrupted.
Read the number of milliamperes now. Whatever that number
is, your aim is to bring it to i/io period of the entire time of the
passage of the current. If the entire period is represented by 20
milliamperes, then i/io will be represented by ten times less ; in
order to obtain this regulate the position of the movable contact
lever of the wheel until the milliamperemeter registers 2 milliam-
peres. The period of the passage of the current is now i/io.
This priod may be regulated by means of the special lever in
the interrupter, and is indicated on the graduated scale provided
for that purpose above the wheel. But a correct graduation in-
volves a great deal of time on the part of the instrument maker,
so that this part alone of the apparatus would cost ten times
more than does the whole interrupter with its motor. Instru-
ment makers will declare that their graduation is perfect, but do
not bother with that. Just take a tiny bit more trouble and regu-
late the period as indicated here, — by means of the milliampere-
meter: The period is of utmost importance in this work.
The Experiment. — Reduce the voltage to zero with the poten-
tial reducer; substitute the patient or animal for the resistance
box and induce anesthesia by guiding the voltage slowly and grad-
ually— by means of the potential reducer. Watch carefully the
voltage and milliampereage, as indicated above.
Regulate the period every time before commencing an experi-
ment. Do not rely on the fact that the period was regulated
for an experiment an hour ago, or the day before. Without your
knowing it, somebody or even yourself may have displaced the
movable lever and so changed the period. This work is like all
other work: the more attention you pay to its details, the better
results it yields.
In case of any untoward symptom in the patient, break the
ELECTRIC ANESTHESIA.— Dr. Robinovitch. 177
circuit by opening the switch. The patient resumes his normal
condition with the breaking of the circuit. With this faciHty to
break the circuit it is impossible to do the patient any harm with
electric anesthesia; unless, indeed, the physician should allow a
patient to remain in the circuit while there are signs of difficult
breathing, cyanosis or of any other accident.
Should syncope take place, however, regardless of all precau-
tion mentioned here, you have everything at your disposal to re-
vive your patient: take off the cathode from the forehead, con-
nect the wire of the cathode with the electrode— 25 x 30 cts. —
placed in the thoracic region; now, practice rhythmic excitations
by closing and breaking the circuit — with the switch: closure —
during J4. or ^ of a second; opening — from i to 1.5 or 2 sec-
onds. If the patient is cyanosed, you will see the cyanosis dis-
appear and replaced by a natural color, normal respiration and
heart beats. But accidents should never happen: we have never
had any untoward accidents in animals.
Clinical Application (presentation of patients). — We pre-
sent two patients on whom we have used electric currents of low
tension and frequent interruption.
The first patient is a chronic alcoholist, who has been treated
here, at the Ste.-Anne Asylum, several times during the last
twenty years. For the last ten years he has been suffering from
left hemianesthesia with marked blunting of the sense of taste
and smell, abolition of the sense of touch, heat and pain.
The patient was subjected to electric currents of from 6,000
to 12,000 interruptions. per minute, period of passage of the cur-
rent i/io, from 20 to 30 volts; cathode, 25x30 centimeters, at
the dorsal region; anode, 12 x 25 cts., at the lumbar region. Dura-
tion of application, 30 minutes, every day during four weeks.
Result : disappearance of all the disturbances, as well as that
of articular pains of ten years' duration (anode, 10 x 15 cts. was
applied to the joints).
The second patient was treated similarly for right hemianes-
thesia of one year's duration ; the patient had previously been
treated by a leading specialist with the ordinary electric cur-
rents and massage, but no improvement resulted. Our treatment
was kept up for four weeks. The patient made a complete re-
covery.
We do not undertake to explain the process by which the cure
has been established; suggestion certainly played no part in the
case of the chronic alcoholist; he objected to the treatment most
energetically — before each sitting. The salient effect of this elec-
tric current is that of changing the blood pressure, as is shown in
178 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, 1909.
all our contributions to this study (see our thesis mentioned
above). Does the heightened blood pressure account for a nutri-
tive change? This is a question for consideration.
On this patient we practiced rhythmic excitations such as one
should use for purposes of resuscitation; from 20 to 90 volts
were used for the excitations. The patient enjoyed the shocks
and laughed as these were practiced. Hence, in cases of apparent
death it is not dangerous to use such voltages.
Note: Electric anesthesia should not be combined with any other form
of anesthesia. In our laboratory operations performed under electric anes-
thesia, preparatory to administering chloroform to the same animal, we
found that the animal was profoundly agitated by the chloroform given
while the electric anesthesia was kept up. The reason of this excessive
agitation is a matter for physiologic study.
Since the publication of this paper, in November, 1908, we have tried,
at Dr. Gwathmey's suggestion, a combination of morphinization and elec-
tric anesthesia. Dr. James Tayloe Gwathmey, of New York, who has
contributed so much valuable work to the physiology of anesthesia,
thought it would be practical to minimize the use of morphine by combin-
ing this with electric anesthesia. We were astonished to find that it was
impossible to combine morphinism with electric anesthesia: a dog fully
morpkinized was excited and agitated when an electric current used for
anesthesia was passed through its body with the head in the circuit, and
a potential of only 1.5 volts. The maximum potential that the animal
could stand without discomfort was one volt. The same animal was sub-
mitted to electric anesthesia when in its normal condition — on the previous
day: the dose used was 9 to 10 volts, registering from 1.5 to 2 milli-
amperes.
RESUSCITATION OF A WOMAM IN PROFOUND
SYNCOPE CAUSED BY CHRONIC MOR-
PHINE POISONING; MEANS USED:
RHYTHMIC EXCITATIONS WITH AN
INDUCTION CURRENT.— THE
AUTHOR'S METHOD AND
MODEL OF COIL.
(From Dr. Magnan's Laboratory, Ste.-Anne, Paris; Directed by
Dr, Louise G. Robinovitch, of New York,)
By Louise G. Robinovitch, B. es L., M.D.
Paris. Member, New York Academy of Medicine; Member,
American Medical Association; Foreign Associate Member,
Medico-Psychological Society, Paris.
December, 1908, a young woman, a chronic morphine eater,
was admitted to the Ste.-Anne Asylum, Paris, Dr. Magnan's
service. She had indulged daily in two grams of morphine dur-
ing a period of two years. When admitted to the hospital, she
was suddenly deprived of her daily dose of morphine. While
waiting to be examined by Dr. Magnan, she had a sudden attack
of syncope. Various means were used to revive her, and she
regained consciousness. We were not present there and cannot
give any details of the means used; when we came into the re-
ceiving ward, the patient was apparently in good condition, but
as Dr. Magnan was talking to us, the patient fell — in a second
attack of syncope : her respirations became slow, shallow, appear-
ing at very rare intervals — perhaps four or five per minute ; the
pulse was almost imperceptible, and her face was blue — almost
black-blue — from asphyxia.
The assistant physicians immediately began to practice on her
artificial respiration by the Sylvestre method and rhythmic trac-
tion of the tongue. These means to revive her were continued
for twenty minutes — without any result. It was not thought
advisable to carry the patient up to our laboratory — on the second
floor, as it was feared that she might expire while being carried
upstairs. Twenty minutes elapsed before we had our special coil
for resuscitation brought downstairs and in working order, the
electrodes in their proper places for resuscitation ; the cathode in
the dorsal region, anode in the lumbar region. Dorsal electrode
measuring 25 x 30 cts., lumbar electrode — 12 x 25 cts.
l80 THE JOURNAL OF MENTAL PATHOLOGY. \^ol. VIII, No, 4, 1909.
The patient was, by this time, quite ''black in the face" and
none of those present expected any good results from the appli-
cation of rhythmic electric excitations. We practiced rhythmic
excitations during a period of about thirty seconds; the dura-
tion of the closure of the circuit was about % of a second; and
the period of the opening of the circuit was about one second.
We shortened the period of the opening of the circuit — as against
our own indications in our papers on the subject of resuscitation,
because the patient seemed to be thoroughly asphyxiated — as we
judged her condition from the color of her face. As the rhythmic
excitations were being repeated, it was astonishing to see the
accompanying change of color in the patient's face; the dark
blue color changed to pale, then to almost natural color; at the
end of the thirty seconds of rhythmic excitations, the patient took
a long spontaneous breath, opened her eyes and said : ''Oh, I feel
so cold in my back." The cold she felt was the wet cotton of
the electrodes, of course. But the interesting point is tliat the
patient felt no other inconveniences during the rhythmic excita-
tions— while she was in profound syncope.
The absence of untoward sensations was to be expected: we
report in another paper, published in this issue, the sensations
experienced by a well person — when subjected to rhythmic exci-
tations caused by a current of low tension and frequent interrup-
tions, with a potential of from 20 to 90 volts : far from experi-
encing untoward sensations, the patient laughed as each shock
was produced, causing artificial respiratory movements.
The potential used for the patient in syncope cannot be indi-
cated in exact figures ; the current was regulated by shifting the
coil so as to obtain sufficiently ample respiratory and cardiac
reactions.
The members of the medical staff who witnessed the opera-
tion declared the method to be far superior to the Sylvestre and
Laborde method: as we have pointed out elsewhere, with our
method we cause artificial heart beats as well as artificial respira-
tions to take place. An assistant clasps the patient's tongue with
a pair of forceps — so as to prevent the lifeless organ from occlud-
ing the larynx, and the operator simply closes and opens the cir-
cuit,— as is indicated in our papers on this subject.
There is no comparison between the results obtained with the
Sylvestre and Laborde methods and those obtained with our
method; the difference, in favor of our method, was particularly
demonstrated in this case of morphine poisoning, — where respira-
tory paralysis is the first feature of the syncope and heart failure
follows as a consequence. The alarming asphyxia, as shown in
RESUSCITATION OF A WOMAN.— Dr. Robinovitch. i8i
the patient's face, did not yield to the usual methods of artificial
respiration; in view of the gravity of the respiratory paresis this
failure to revive the patient by means of the combined Sylvestre
and Laborde methods was natural: the ordinary artificial respi-
rations at their best do not compare in amplitude with those ob-
tained by means of electric rhythmic excitations : with the latter
the chest can be expanded to its maximum capacity: in the case
of respiratory asphyxia this facility to supply fresh air is of the
utmost importance. Besides, respiratory movements alone do
not suffice to revive an asphyxiated subject: heart beats throwing
oxygenated blood into circulation are quite as essential ; with the
ordinary means of artificial respiration we do not obtain the re-
quired conditions; but with the electric rhythmic excitations we
obtain both artificial respirations and heart beats of required
amplitude.
The facility with which the patient was revived by means of
electric rhythmic excitations did not astonish us ; in laboratory ex-
periments we never failed to revive animals within a few sec-
onds, if the rhythmic excitations were begun before life was
completely extinct — while there were still signs of spontaneous
respiration or heartbeat. While with the ordinary methods, as
was shown in the case of this patient, artificial respiration and
rhythmic traction of the tongue accomplished nothing within a
period of twenty minutes. It is not possible to know whether
the patient would have been revived with the old method after
that period. The condition of the patient was alarming when she
was handed over to us for the application of electric rhythmic
excitations.
From the standpoint of utility in surgical cases, in which a
patient suddenly lapses into syncope during the administration of
chloroform, this case is most instructive : with the electrodes ad-
justed under the patient, — before the chloroforming and the
operation is begun, — the surgeon need not fear a sudden attack
of syncope in his patient: a few rhythmic excitations with the
electric current invariably brings the subject back to life ; we have
demonstrated this in hundreds of cases of dogs, whose hearts
are highly sensitive to chloroform poisoning or electrocution. The
readiness with which resuscitation may be practiced by means
of rhythmic electric excitations contrasts strongly with the diffi-
culty encountered when using the Sylvestre-Laborde methods, —
as was illustrated in the case just related. The facts certainly
speak in favor of our method.
DIFFERENT EFFECTS OF VARIOUS ELECTRIC
CURRENTS. CHOICE OF THE ELECTRIC
CURRENT FOR PURPOSES OF RESUS-
CITATION OF SUBJECTS IN A CON-
DITION OF APPARENT DEATH
CAUSED BY CHLOROFORM,
MORPHINE, ELECTROCU-
TION, ETC.*
By Louise G. Robinovitch, B. es L., M.D., Paris, Member, New
York Academy of Medicine; Member, American Medical
Association; Foreign Associate Member, Medico-
Psychological Society, Paris.
Different electric currents have various effects on cellular life.
In a series of experiments on dogs and rabbits, we found that in
the matter of electrocution, the alternating was the most danger-
ous current to cellular life; next in destructive effect to vitality-
was the continuous current; next to this was the induction cur-
rent; and the least destructive of lethal currents was the cur-
rent of low tension and frequent interruption.
Thus, a dog electrocuted with an alternating current, so that
there was suspension of blood pressure in the carotid artery and
of respiration for some two minutes, could not be resuscitated
by practicing on it rhythmic excitations with the same current.
A dog electrocuted with a continuous current, so that blood
pressure in the carotid artery and the respiration were suspended
for two minutes, could not be resuscitated by practicing on the
subject rhythmic excitation with the same current.
But a dog electrocuted with a continuous current could be re-
suscitated by practicing on it rhythmic excitations with a current
of low tension and frequent interruptions.
A dog electrocuted with an induction current could not be re-
suscitated with rhythmic excitation with the same current, but
could be resuscitated by causing rhythmic excitations with a cur-
rent of low tension and frequent interruption.
A dog electrocuted with a current of low tension and frequent
*An abstract of our findings on the various effects of different electric
currents was presented at the Congress of Neurologists, held in Geneva,
Switzerland, August 1-7, 1907, and at the International Congress of Neu-
rology and Psychiatry, held at Amsterdam, Holland, September 2-y, 1907.
DIFFERENT EFFECTS OF VARIOUS CURRENTS.— Dr. Robinovitch. 183
interruption is resuscitated with the same current with greater
facility than is an animal electrocuted with any of the other dan-
gerous currents mentioned.
We use the term ''alternating," "continuous," "induction,"
current, etc., in the large meaning of the word; for in reality
each variety of current has its sub-varieties, — according to the
way in which it is obtained. Thus, the induction current is a
deadly current to animal life; but the deadly effects of this kind
of current vary with the resistance in the coil used. If the coil
is of medium sized wire, say 6/10 mm., an electrocution with a
current from this coil is far less fatal than is an electrocution
with a current from a coil of finer wire.
For purposes of resuscitation, the choice of an induction cur-
rent should be governed by this fact; a coil of finer wire than
6/10 mm. should never be used.
The marked vital disturbances produced by a lethal current
taken from a coil of fine wire (No. 3 coil, of the Dubois-Rey-
mond apparatus) are illustrated in our thesis, entitled "Sommeil
electrique, epilepsie electrique et electrocution, Paris, 1906, pp. 82,
83 ; trace No. 27 in this thesis shows that the blood pressure in
the carotid artery during an electrocution with an induction cur-
rent is not nearly as high as it is in electrocutions with other cur-
rents. We shall not analyze here the reason of this difference;
but the fact is stated simply to point out the different physiologic
effect of different currents. Some day in the future, neurologists
will wake up to the fact that it is important to know the value
of electric currents applied daily in clinical work: it is easy to
prescribe for patients "strong" or "weak" currents — as these are
obtained with induction coils of fine or coarse wire of a Dubois-
Reymond apparatus ; but it is also important to know the re-
spective physiologic effects of these currents.
In our estimation, in the future, the choice electric current for
use in neurologic clinics will be the current of low tension and
frequent interruption. This current can be measured to minimal
practical doses, — from one volt or even a fraction of one volt up,
and the operator can direct at will the blood pressure in the limb
under treatment, without subjecting the patient to any untoward
after effects.
The blood pressure and respiration under the influence of this
current is fully illustrated in the traces in our thesis above cited.
The effect of various electric currents in resuscitating elec-
trocuted animals applies equally to the resuscitation of subjects
in a condition of apparent death from various causes: chloro-
form, morphine, etc. For purposes of resuscitation, the current
of low tension and frequent interruption is the best.
PRESENTATION OF INSTRUMENTS: MOTOR
INTERRUPTER SUPPLYING A CURRENT OF
FREQUENT INTERRUPTIONS FOR
ELECTRIC ANESTHESIA.*
By Dr. Louise G. Robinovitch, New York.
The motor-interrupter for electric anesthesia made for Profs..
Leduc and Rouxeau, is described in our thesis, Paris, 1906:
"Sommeil Electrique, Epilepsie Electrique et Electrocution." This
interrupter presented the inconvenience of causing muscular
tremor and rigidity of the animal. The second model made by
the same house in Paris was discarded by us as a dangerous in-
strument for this work. Since that time we have modified every
detail of the interrupter.
With our own model of the motor-interrupter, made by Gaiffe,
we obtain electric anesthesia without muscular tremors or rigid-
ity; the animals limbs remain in a normal condition during the
entire duration of the anesthesia.
The Wheel-Interrupter. — The wheel of the first models was
made of compressed fiber enclosed in a metallic armature, the sec-
tors of which were united by means of metalHc plates running
through the thickness of the compressed fiber. There was a dis-
advantage in this construction because compressed fiber changes
in shape under the influence of electric currents ; and in the
course of time the wheel became elHptical; this shape was not
perceptible to the naked eye, but the contact with the levers was
changed, and the animal suffered from the irregularity of the
current on this account ; muscular tremors and rigidity were due
in great part to this cause.
In our model all the elements of the wheel are changed: the
wheel is made on the principle of a commutator; it is made of
metal and the insulator is mica. This construction does away
with the inconveniences found with the wheel made of com-
pressed fiber. The interior of the wheel is covered with mica
and the metallic armature is insulated from the mass of the wheel
* We are considering the utilization of a newer variety of electric cur-
rent— obtained without mechanical contacts; this current is highly regu-
Ieu- and reliable. November, 1909.
PRESENTATION OF INSTRUMENTS.— Dr. Robinovitch. 185
by a layer of mica 15/10 mm. thick. The insulators between the
sectors of the metallic armature are made of ebony or compressed
fiber. In the interior of the wheel the sectors are connected by
means of wire of large diameter.
The levers of the wheel are made as flexible and adjustable as
possible so that contact with the wheel is easy and soft without
bearing too much pressure on it. The joints of the levers are
made on the principle of steel springs in the newest registering
tambours of Marey, made by M. Boulitte, of Paris. The end of
the lever that is in contact with the wheel is made of layers of
copper netting. Perfect contact with little pressure is obtained
with these flexible levers. The pressure of the springs and the
contact of the levers are regulated by means of pressure screws.
The movable lever is mounted on an endless screw. This
lever is surmounted by an index needle or hand that reaches to
a graduated scale above the wheel. The endless or microscopic
screw is below the wheel. The position of the movable lever is
changed by means of the endless screw ; the needle gliding along
the graduated scale indicates the period of the passage of the
current. The contrivance for regulating the period is perfected
in our model as much as possible ; but in our own work we never
rely on indication thus obtained: the process of graduating the
scale requires much time of a skilled mechanic; and the price
of an accurate scale is expensive. We regulate the period by
means of the milliamperemeter, as is indicated in our paper on
electric anesthesia, published in this issue.
The period of the passage of the current is regulated by chang-
ing the position of the movable lever in relation to the immov-
able lever ; the change of position is made by means of the end-
less screw.
For testing the speed of the motor we use Dechiens' tachy-
meter. In our model the tachymeter is adjusted to the axis of
the motor on the principle of a piston within a syringe; so that
the tachymeter may be put into action to indicate the number
of turns and then withdrawn. We have had this arrangement
made so as to avoid unnecessary bearing of weight or friction on
the axis of the motor. In our own work we prefer a tuning fork
to a tachymeter.
The so-called tachymeter furnished by Gaiffe with his second
model of interrupter was discarded by us — together with the
?notor and interrupter, three years ago. That tachymeter is
used for automobiles, but should not be used for work of
precision.
Of the small motors running on from 16 to no volts, tna*
j86 the journal of mental pathology. Vol. VIII, No. 4, 1909.
known as type Contremoulin-Gaiffe is the most regular motor.
Motors of the type generally used for ventilators have given us
most disastrous results on account of the irregularity in their
course. These motors heat up quickly; the resistance is changed
and consequently the speed is changed. The animal in the cir-
cuit is the sufferer thereof.
For more serious work we have had a special motor made for
us by Sautter and Harle, Paris ; this is a powerful motor, running
slowly but regularly.
The physician should not take any medical electrician's advice
on the regularity of a motor: what appears to be regular to the
mechanic does not always prove to be regular to the physiologist.
We have tested almost every type of motor in the market and
have not found any that approach to the pretense of regularity
except the motors mentioned as such, and even these two are
not the most satisfactory ones.
The essential qualities of a motor-interrupter for purposes of
electric anesthesia consist of regularity in the course of the
motor; flexibility of the contact levers at both commutators and
in the regularity of form of the wheel.
Within the limits of possibility these conditions are fulfilled in
our model.
Electric Source for the Motor. — The electric source for
running the motor should be separate from the electric source
used for causing anesthesia, and both sources should be furnished
by storage batteries of large capacity.
Electricians will tell you that the alternating current will run
the motor more regularly than any other current. Don't pay
any attention to the electrician: if you followed his advice you
would kill your patient in the circuit, with a motor running on an
alternating current.*
Do not use ordinary wet batteries for your electric source : the
cliemical decomposition goes on too rapidly, and the stability of
the current is impaired.
Do not use the direct city current for running the motor : we
have tried it and discarded its use in our work.
* For the last few years, we have been insisting on the danger of using
any other electric currents than those indicated by us.
Presented at the Societe clinique de medecine mentale, and published
in the Bulletin de la Societe clinique de medecine mentale, November,
1908.
Fig. I. — Dr. Robinovitch's model of interrupter: i, potential reducer; 2, motor-interrupter; 3, milliamperemeter ; 4, switch; 5, voltmeter;
, 6, enlarged view of motor-interrupter; 7, interior of wheel; 8, endless screw; 9, movable lever; 10, fixed lever; 11, hand movmg
with movable lever; 12, graduated scale; 13, rheostat for motor.
INDUCTION COIL SPECIALLY CONSTRUCTED
ACCORDING TO OUR INDICATIONS FOR
PURPOSES OF RESUSCITATION OF SUB-
JECTS IN A CONDITION OF APPARENT
DEATH CAUSED BY CHLOROFORM,
MORPHINE, ELECTROCUTION,
ETC.*
For purposes of resuscitation we consider the current of low
tension and frequent interruption superior to all other currents.
But for practical purposes in cases of accident where this current
cannot be had, we use an induction current supplied by a coil of
large size especially constructed for the purpose of resuscitating
human beings. It is an ordinary induction coil, the wire of which
is 6/10 mm. in diameter. We do not know the exact number of
layers used, but the whole coil weighs about seven kilograms;
the weight of the wood enclosing the core is estimated at about
50 grams. The core measures about one inch in diameter. The
diameter of the wire of the primary coil is 12/10 mm. ; six layers,
of wire is used. The voltage of this coil is high. The amperage
should be calculated. The proper potential for the rhythmic ex-
citations is obtained by shifting the position of the secondary coil.
The diameter of the wire of the coil is of utmost importance for
purposes of resuscitation. Do not allow your electrician to use
any wire of smaller diameter than 6/10 mm. In our experiments
on animals we failed to resuscitate subjects when using the coil
of fine wire of the Dubois-Reymond apparatus; we succeeded
only with the coil of middle size, No. 2, the wire of which meas-
* Since the presentation of this paper at the Societe clinique de m6de-
cine mentale, Paris, November, 1908, we have constructed a new coil that
is far superior to the one just described (see description of new coil in
this issue).
l88 THE JOURNAL OF MENTAL J^ATHOLOGY. Vol. VIII, No. 4, 1009.
ures about 6/10 mm. in diameter. We reported this fact to various
medical congresses. (See our paper entitled: "Method of Resus-
citating Electrocuted Animals," etc., Journal of Mental Path-
ology^ Vol. VIII., No. 3, 1907.) Do not allow your electrician to
mix the layers of wire, using fine and coarse wire : all the layers
should be of the same diameter.
In our induction coil an appropriate condenser for the primary
coil is placed at the bottom of the apparatus. The apparatus is
run on 8 volts of accumulators, capacity — 40 amperes.
The rhythmic excitations are caused by opening and closing the
secondary current with a switch. Do not commit the error of
opening and closing the circuit by means of the switch at the
direct current or the inducing current: such an error during re-
suscitation of a patient may cost you your patient's life — through
loss of time in re-establishing the induction current after each
opening. If in doubt as to the proper switch, interrupt your sec-
ondary current by touching the terminal of the coil with the
wire that is usually screwed into this terminal — at the negative
pole.
Under such conditions, instead of screwing the end of the con-
ducting wire into the terminal of the coil, hold the end in your
hand ; close the circuit by touching the terminal of the coil with the
end of the wire in your hand; open the circuit by taking away
the end of the conducting wire from the coil terminal.
In a case of emergency, and in the absence of a switch, we have
recently resuscitated a patient by this means.
Your electrician will assure you that a finer wire in a coil gives
a "stronger" current. By this he means that the current is more
painful to normal subjects; as indeed, it would be impossible for
you to stand the pain caused by currents of the fine wire coil, or
coil No. 3, of the Dubois-Reymond apparatus — when the coil is
advanced near zero of the scale ; but you easily stand the discom-
fort caused by the coil of coarser wire, coil No. 2, even when the
coil gives its maximum potential. But do not listen to the elec-
trician: insist on having the diameter of the wire for the coil
not less than 6/10 mm. or you will lose your patient by using a
coil of finer wire.
The facts we state are based on laboratory work. We have
failed to resuscitate electrocuted animals when using No. 3, or
fine wire coil, of the Dubois-Reymond apparatus. The failure
was due to insufficient or even absent cardiac and respiratory
reaction. We pointed out the fact that the fine wire coil, while
deadly to cellular life, causes only a slight increase of blood
pressure as compared w^-h the action of the coarser wire coil.
INDUCTION COIL FOR RESUSCITATION.— Dr. Robinovitch. 189
This important fact accounts for the failure to revive electro-
cuted animals with currents supplied by fine wire coils. (See p.
82 of our thesis, entitled "Sommeil Electrique, Epilepsie, Elec-
trique et Electrocution," Paris, 1906. Also see trace No. 26, on
p. 8;^, showing the slight elevation of blood pressure with a fine
wire coil.)
No. I, or coarse wire coil of the Dubois-Reymond apparatus is
useless for purposes of resuscitation, — ^the amperage of the cur-
rent is almost nil. But No. 2, or medium coil, gave us good re-
sults.
Needless to remark that the coil of our own model is many
times more effective than is the coil of the Dubois-Reymond
apparatus. For purposes of resuscitating human beings the Du-
bois-Reymond apparatus is useless ; our model of coil should be
used, and our latest model, described in this issue, should be
chosen.
Jolyet's Cannula, Modified by Dr. Louise G. Robinovitch.
— The modification of the cannula has been made for the purpose
of avoiding accidental separation of the cannula from its faucet ;
such an accident happened to us while registering the blood pres-
sure in the carotid artery of an animal, a serious hemorrhage
resulting from the mishap. The modification or perfection is as
follows below :
The crown of the hollow piston of the faucet is furnished with
a latch ; while a corresponding notch is made in the crown of the
cannula. When the latter is inserted in the large blood vessels, the
hollow piston is inserted into the cannula so that the latch passes
through the notch; then the piston is turned a few millimeters
inside the cannula ; this movement locks the cannula in a way sim-
ilar to that in which a window latch locks a window. (See Fig.
No. I.)
A Two Cylinder Registering Apparatus. Professor Roux-
eau's Model (Nantes). — Professor Rouxeau, of Nantes,
France, has made a convenient modification of Marey's register-
ing apparatus : the three columns of support for each drum are
eliminated — together with the plates that the columns supported
above and belov/ each cylinder. The convenience of not having
these plates is that the paper used for registration may ascend or
descend above or below the cylinders — without stopping the
course of the apparatus — by reason of the obstacle in the shape
of those plates. Each cylinder is supported by one strong metal
brace. (See Fig. No. 2.)
igo THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i, 1909.
Professor Rouxeau has also eliminated the vessel for holding
a solution of water and glycerine or any other substance, destined
to regulate the speed of the apparatus : an appropriate motor an-
swers the purpose and does away with the inconvenience of es-
caping drops of liquid — on the blackened paper.
The support for the various registering instruments, — ^tam-
bour, chronograph, etc., is also conveniently modified. (See
Fig. 3-)
The simple stem of support of Marey's apparatus does not
always suffice for placing properly all the registering instruments ;
Professor Rouxeau has made an excellent modification in the
stem.
The vertical stem is enveloped in a metal sheath or hollow tube ;
by means of a pressure screw this metal tube may be fixed at
any height along the vertical stem. Two transverse bars are
mounted on this sheath ; one end of the lower one is fixed on the
sheath, encircling it with a ring ; a pressure screw going through
the ring and the sheath, makes it possible to displace and fix the
sheath at any height on the stem. The bar itself is for the pur-
pose of changing the position of the sheath.
The upper bar is somewhat more complicated: it is 13 centi-
meters long, 15 mm. high, and 3 mm. thick; two vertical stems
are mounted on this bar ; each vertical stem can be placed at any
desired position on the horizontal bar; the stems are fixed in
their respective positions by means of pressure screws.
With this arrangement of vertical stems it is possible to mount
several registering instruments without inconvenience.
A Hand Signal. — By Dr. Louise G. Robinovitch, of New
York.*
The hand signal is used in physiologic experiments and may
be substituted for the electric signal. This signal has been made
on the principle of Professor Rouxeau*s signal. Our model con-
sists of an ordinary coarse tambour of Marey ; the metal tube of
the tambour is connected with a rubber tube and bulb, — such as
are used in photographic apparatus; a metal horseshoe with a
pressure screw surmounts the lever. The rise of the lever is re-
stricted and can be regulated with the pressure screw. When
pressing on the rubber bulb, the lever rises ; when releasing the
bulb, the lever falls ; the signal is traced on the paper during the
rise and fall of the lever. We use this signal instead of Deprez'
signal.
* Presented at the July meeting, 1908, Societe Clinique de Medecine
Mentale, Paris.
A HAND SIGNAL.— Dr. Robinovitch. 19I
We thank M. Boulitte, of Paris, for having helped us simpUfy
this instrument.
A Portable Chronograph Giving Scale Traces. — By Dr.
Louise G. Robinovitch, of New York.*
The chronograph giving second traces, thus : | | each hori-
zontal line = a second, consist of a pendulum clock, the pen-
dulum causing interruptions in an electric circuit. Such chrono-
graphs are in use by Professor Rouxeau, of Nantes; Dr. Bull,
of the Institut Marey, in this laboratory, etc. We present to-day
a portable chronograph made according to our indications and
that may be substituted for the clock chronograph.
The principle on which our chronograph is made is similar to
that of other chronographs : the period of seconds is obtained by
means of a mechanism of an ordinary clock work ; and the inter-
ruptions every second are obtained by means of breaks in an elec-
tric circuit every second : the clock work causes the motion of a
notched wheel and a lever falls from one notch on the other suc-
cessively— every second — while the wheel is in motion ; the time
of contact of lever with each notch and of fall on each notch is
equal — one second. An electric current of ordinary bichromate
cells is made to pass so that the circuit is closed at each contact of
the lever with a notch on the wheel; the circuit is open — during
the fall of the lever from one notch upon the one following ; these
successive closures and openings of the circuit are registered by
lines — known as ladder scale traces ; the lines are traced by a
Deprez signal in the same circuit with the wheel, as you may see
in the arrangement of the instruments before you.
* Presented at the July meeting, 1908, at the Societe Clinique de Mede-
cine Mentale, Paris.
THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, 1909.
^J
^-■
s 1
H
O
EXPERIMENTAL LESION OF THE SPINAL CORD
PRODUCED BY MEANS OF LETHAL ELEC-
TRIC CURRENTS. DIFFERENT EF-
FECTS OF VARIOUS ELECTRIC
CURRENTS.
(A preliminary communication.)
By Louise G. Robinovitch^ M.D., New York.
In 1905, while working in Rome, Italy, we produced in a
rabbit an experimental lesion of the lumbar region of the spinal
cord by means of repeated shocks with lethal electric currents.
The animal was submitted to an electric current supplied by
wet bichromate batteries ; the potential was seventy volts, show-
ing about 20 to 30 milliamperes, — while the current was being
interrupted some three hundred times per minute with an ordi-
nary vibrating rod. The negative electrode — 4 x 4 cts. was ap-
plied to the forehead and the positive electrode, 10 x 10 cts. was
applied to the lumbar region. This current was about five times
stronger than is necessary to electrocute a rabbit; the time of
application of the current was about one minute and was re-
peated several times every day duriig three or four days. After
the last application of the shock the animal showed weakness
of its posterior limbs; this condition developed into frank par-
alysis of the hind legs on the following day; sensation to pain
caused by pricking with a needle was retained but motion was
completely impaired, the animal dragging its hind legs when
changing position. There seemed to be fecal and urinary incon-
tinance. Death followed within about a week.
Since 1905, we have produced experimentally similar par-
alytic conditions in rabbits by subjecting them to lethal shocks
with induction currents, the shocks being prolonged until ap-
parent death seemed to be imminent. These shocks were re-
peated several times daily for three or four days until paralysis
of the hind legs set in.
This spinal lesion is not easily obtained in all rabbits subjected
to the experiment; it was only in exceptional cases that the
lesion was obtained ; some of the animals were ordinary do-
mestic rabbits while others were Belgian hares. But the possi-
bility of causing such lesions with induction currents and slowly
and irregularly interrupted currents (300 times per minute with
a vibrating rod) is a fact worthy of notice.
Indeed, these experiments seem to point once more to the im-
portance of choice of electric currents for application in man.
IQ4 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 4, 1909.
In 1906, we pointed out the danger accompanying the use of the
positive pole at the forehead and of the appHcation of induction
currents when the cerebro-spinal axis was in the circuit (i). In
1907, 1908 and 1909, we presented our studies on the different
effects of various electric currents for purposes of resuscitation
of subjects in a condition of apparent death (2) ; and our pres-
ent experiments lead us to caution neurologists once more
against the indiscriminate application, in clinical neurology, of
induction currents and of currents with undifferentiated poles.
In our opinion the safest current is the one of low tension and
frequent interruption, that we use for producing electric anal-
gesia and for resuscitation. We applied this current to a rabbit
during a period of eight hours and twenty minutes without caus-
ing any after effects (3). We never caused any spinal lesions
in dogs subjected to electrocution and resuscitation by means of
this current. We generally subject dogs twice to electrocution
and resuscitation; the first time the blood pressure is taken in
the carotid artery, the operation being performed while the ani-
mal is under the influence of electric analgesia; the second op-
eration is performed on the femoral artery — under similar condi-
tions,— some four to six weeks after the first operation. We
generally use 120 volts, showing some 140 milliamperes, for elec-
trocuting dogs. The duration of electrocution is from a few
seconds to 2 minutes ; the duration of resuscitation is from a few
seconds to from 3 to 3.5 minutes, according to the case. Some
dogs we kept for over a year after the second operation, but
they did not present any lesions at all.
The questions that present themselves in connection with these
experiments are as follows:
I. Are rabbits especially susceptible to lesions of the lumbar
region of the spinal cord when subjected to strong and repeated
electric shocks with induction currents?
1. Dr. Louise G. Robinovitch. — Sommeil electrique, epilepsie electrique
et electrocution, thesis, Paris, 1906, pp. 34 to 43.
2. Dr. Louise G. Robinovitch. — Method of resuscitating electrocuted
animals, etc. Journal of Mental Pathology, Vol. VIII, No. 3, 1907.
De I'emploi des courants electriques pour le rappel a la vie, dans les
cas de mort apparente causee par le chloroforme ou par I'electrocution :
necessite d'exclure du circuit la tete pendant les excitations rythmiques,
etc. Bulletin de la society clinique de medecine mentale, No. 4, Novem-
ber, 1908.
Methode de rappel a la vie des animaux en syncope chloroforrnique et
des animaux en mort apparente cause par I'electrocution. Effets differents
de differents courants electriques. Importance d'exclure du circuit la tete
de I'animal pendant les excitations electriques. Comptes rendus des
seances de la societe de Biologie, February i, 1908, T. LXIV, p. 167.
Different effects of various electric currents. Choice of current for
resuscitation, — in this issue.
3,. Louise G. Robinovitch. — Thesis cited, pp. 32 and 33.
TRIPLE INTERRUPTER OF DIRECT CURRENTS.— Dr. Robinovitch. 195
2. Is the Belgian hare especially susceptible to such lesions?
3. Is the positive pole more destructive to cellular life than is
the negative pole? (See our thesis: Sommeil electrique, epi-
lepsie electrique et electrocution, Paris, 1906, pp. 34 to 43.)
4. Is the lumbar region of the rabbit or the Belgian hare less
resistant than is any other region of these animals' spinal cords?
Lesions of various parts of the body have been reported as re-
sults of electric shocks, but the pole at which the lesion was
caused is, of course, not known. Professor Battelli reports
opacity of the cornea of animals (dogs, guinea pigs) as a result
of shocks with alternating currents (4).
The current of low tension and frequent interruption that we
use for electrocution and resuscitation as well as for producing
analgesia has never left any effects. In man we apply this cur-
rent to the eyes during a period of one hour, during a week,
without causing any after effects. In one case we applied this
current to the eyes of a patient for relieving high tension in the
eye-balls accompanied by headache. The relief was complete.
Three-quarters of a milliampere were used. We apply a similar
current for causing sleep in man : no after effects have resulted.
The duration of application was one hour daily during a week.
We are conducting a series of experiments on the various ef-
fects of different electric currents when applied to the eyes. The
results will be reported in another paper.
The microscopic studies of the lesions of the spinal cord will
be reported later.
4. Battelli. — La mort par les courants electriques ; courant alternatif a
has voltage et a haute tension. Journal de Physiologie generale, No. 3,
1899.
TRIPLE INTERRUPTER OF DIRECT CUR-
RENTS FOR RESUSCITATION. POR-
TABLE MODEL FOR AMBULANCE
SERVICE.
By Louise G. Robinovitch, M.D., New York.
For purposes of resuscitation the preferred current is the one
of low tension and frequent interruption. The current obtained
with our model of interrupter described in this issue gives us
good results but the apparatus is rather heavy for transportation
in ambulance service. We have constructed a triple interrupter
ip6 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. i, 1909.
of direct currents that gives good results in laboratory work and
is portable and suitable for ambulance service.
The apparatus consists of three separate primary induction
coils, with their cores ; each coil is run on four dry battery cells ;
the three coils are placed side by -side, but are not connected in
any way. Each primary coil with its core is utilized for the pur-
pose of causing the vibration of a steel ribbon ; a contact button
that is insulated from but fixed to the ribbon, is attracted and
released at the core of the coil, and the steel ribbon vibrates as
the makes and breaks take place. The rapidity of vibrations
of the steel ribbon is regulated in a manner similar to that in
which one regulates the rapidity of vibrations of a violin string ;
the tighter the ribbon the more rapid are the vibrations; the
range of vibrations of the ribbon is between 15,000 and 25,000
per minute. The vibrations of this ribbon are utilized for the
purpose of making and breaking the circuit of a simple direct
current as follows : a delicately arranged spring lever contact
touches the side of the vibrating ribbon every time the ribbon
is released from the core; this contact lever is separated from
the ribbon every time the ribbon is attracted toward the core.
We thus have a system of makes and breaks between the rib-
bon and the spring lever.
The lever is in the circuit of a direct current of any voltage
chosen, say the street current. This current is controlled with
a suitable potential reducer so that one may utilize from a frac-
tion of a volt to 120 volts. Makes and breaks of the circuit of
the direct current take place as the steel ribbon vibrates and
touches or separates from the contact lever. The rapidity of
the makes and breaks depends on the rapidity of the vibrations
of the steel ribbon. Suppose the ribbon vibrates 15,000 times
per minute; the direct current is then interrupted 15,000 times
per minute. The direct current thus interrupted is then led to a
second vibrator, at the second coil, causing say 5,000 interrup-
tions per minute; the direct current is now interrupted 20,000
times per minute; this interrupted current is now led to a third
interrupter, at the third coil, causing, say, 5,000 interruptions per
minute; the direct current is now being interrupted 25,000 times
per minute. Each interrupter can be regulated to give more in-
terruptions, so that the direct current may be interrupted some
40,000 to 50,000 times per minute. A voltmeter in shunt and a
milliamperemeter in series measure the current used.
Relative physiologic value of direct and interrupted
CURRENTS FOR PURPOSES OF RESUSCITATION. — Physiologically the
direct current causes less marked cardiac and respiratory reac-
u
o
c
U
'0061 'I' -ON 'IIIA '^OA 'AyOlOHlVd 'IVXNHJAI dO ^IVN^iaOi' aHX
PHYSIOLOGIC EFFECTS OF A NEW CURRENT.— Dr. Robinovitch. 197
tions, than does the same current when interrupted ; and slow in-
terruption causes less marked reactions than does rapid interrup-
tion, as is explained below.
One of us in the laboratory took into his hands the electrodes
in the circuit of a simple direct current. The circuit was sud-
denly closed with a switch, the meters registering 20 volts and
2.5 milliamperes ; the energy of muscular contraction was noted
arbitrarily as i. This direct current was now interrupted 15,000
times per minute; the circuit was closed as before, and the me-
ters showed 20 volts, but only 1.5 milliamperes, and the energy
of muscular contraction was 3 times stronger than was that ob-
tained with the direct current. Finally, the current was inter-
rupted with the second interrupter 20,000 per minute, the circuit
closed as before; meters showed 20 volts, only 0.5 milliamperes,
but the energy of muscular contraction was estimated as being 6
times stronger than was that obtained with the same voltage of
the direct current. These effects are summarized below :
Direct current, 20 volts, 2.5 milliamperes, energy contract, i.
15,000 inter., 20 volts, 1.5 milliamperes, energy contract. 3.
20,000 inter., 20 volts, 0.5 milliamperes, energy contract. 6.
These effects seem to be astonishing, but they are facts : the
direct interrupted current gives better results for resuscitation
than does the simple direct current. Besides, the direct inter-
rupted current, with its low amperage does not exhaust the car-
diac and respiratory reaction as rapidly as does the simple direct
current.
INDUCTION COIL FOR PURPOSES OF RESUSCITA-
TION.— This coil is made on lines similar to those given in the
description of our first model described in this issue : the wire of
the primary coil is 12/10 mm. in diameter, and that of the secon-
dary coil is 0.6 mm. in diameter ; there is a condenser in the pri-
mary circuit. In the present model the secondary coil is made
in sections controlled by a button switch, so that part or all of
the current may be utilized. The vibrator is a steel ribbon that
can be made to vibrate some 25,000 times per minute. This coil
gives better results than did our first model of coil. But our pre-
ferred current for resuscitation is the one of low tension and
frequent interruption as it is obtained with our model of the
wheel interrupter; the triple interrupter also gives good results
for resuscitation. The induction current obtained with our model
of coil is our third choice, although we have had good results
from its use in animals as v/ell as in man.
PHYSIOLOGIC EFFECTS OF A NEW VARIETY
OF ELECTRIC CURRENT.*
By Louise G. Robinovitch, New York.
Within the last few days we came across an apparatus pro-
ducing electric currents of great regularity. The current is a
sinusoidal one of very pure and smooth wave form and its fre-
quency may be controlled at will. The regularity of the wave
results from the fact of its being obtained by a purely electrical
method (by means of the action of a magnetic field on the cur-
rent in a mercury vapor tube) without moving mechanical parts
or contacts. The apparatus is capable of producing either a pure
alternating current that reverses at regular periodic intervals or
a pulsating current that has the same sinusoidal wave form but
flows always in one direction without reversing.
We tested the value of the pure alternating current for pro-
ducing general anesthesia. The subject was a rabbit. One elec-
trode 4x4 ctms., was aplied to the forehead, the other, 10 x 10
ctms., to the loins. The current was a simple alternating one,
but its wave form was of great regularity.
In the beginning of the experiment the animal's temperature
was 99 degrees F., respiration 50 per minute. The frequency
of the current was 1,100 cycles per second, the intensity was
6 milliamperes. After 20 minutes the animal's temperature
rose from 99 degrees F. to 101.8 degrees F., and the respirations
became so rapid that they could not be counted. The reflexes
were highly exaggerated. The objectionable effects of this al-
ternating current were similar to those obtained by us from the
application of ordinary induction currents, in which case the
animal succumbed with high fever and rapid respirations (i).
This experiment confirmed once more our claim that it is dan-
gerous to utilize alternating and induction currents in living
beings.
At our suggestion, Mr. Frederick K. Vreeland kindly con-
sented to modify the character of the current obtained with his
oscillator (2) so that the simple alternating type that reverses
was replaced by a pulsating type, that has the same sine wave
* Presented at the New York Academy of Medicine, November 4, 1909,
and before the New England Association for Physical Therapeutics, No-
vember 12, 1909.
I. Dr. Louise G. Robinovitch. — Sommeil electrique, epilepsie electrique
et. electrocution, thesis, Paris, 1906, p. 43.
PHYSIOLOGIC EFFECTS OF A NEW CURRENT.— Dr. Robinovitch. ipg
form but does not reverse. This pulsating current is made up
of two component parts : one — alternating and the other — direct
that can be combined in any desired proportion. The best re-
sults— when applied to an animal — were obtained when the al-
ternating component was about 0.7 of the direct component; so
that the resultant pulsating current just came to zero in each
cycle without reversing.
We submitted a rabbit to this pulsating current, with the
cathode at the head and the anode over the loins. The animal
fell into a perfectly quiet state of relaxation under the following
conditions :
Pulsating current — frequency 125 cycles; direct current com-
ponent 5.7 milliamperes, alternating component 4.2 milliamperes.
At the beginning of the experiment the animal's temperature
was 100 degrees F., respiration 80 per minute. The animal was
excited: it had been in a basket for two hours previous to the
experiment. Normally, a rabbit's respirations during October
are about 50 per minute, temperature, 99 F.
After being under the influence of the current for three hours,
the temperature had fallen to 99.6 F. and the respirations were
about 40 per minute.
While under the influence of this current the rabbit rested
quietly and there was no muscular rigidity. The reflexes were
less exaggerated than in the first experiment, but still exag-
gerated so that the slightest movement of air caused the animal
to react. Sensibility to pain seemed to be less than normal;
there was no reaction when a needle was thrust through its skin.
But as the subject was a rabbit no definite conclusion should be
drawn on the question of sensibility until further research have
been made on dogs. Consciousness was not deeply suspended.
When the circuit was opened the animal instantly arose to its
feet in a perfectly normal condition.
Other experiments were made using different frequencies and
current intensities, but the conditions indicated above seemed
to be most favorable. We then made a longer test of this cur-
rent, subjecting to it a rabbit for a period of eight hours without
interruption. The animal was in normal condition at the end
of the experiment.
We tested the same current on one dog. The effects observed
were similar to those obtained in the rabbit of the second ex-
periment, but the temperature always rose to from loi to 102
2. Frederick K. Vreeland. — A sine wave electric oscillator of the organ
pipe type. Physical Review, Vol. XXVII, No. 4, October, 1908.
200 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VIII, No. 1, 1909.
degrees F. after the animal had been in the circuit an hour or
more.
We reserve our conclusions on the effects of this current until
further researches into its value have been made. For the pres-
ent we have suggested to the author of the apparatus to make
certain modifications of the character of the current that will
reduce the period of the passage of the current to i/io of the
entire time.
THE JOURNAL OF MENTAL PATHOLOGY
Edited by Louise G. Robinovitch, B. es L., M.D.
Vol. VIII. 1909. No. 4.
STATE PRESS, Publishers,
L. G. ROBINOYITCH, M.D., PRES.
28 W. 126th St.
New York.
MSS. and Communications should be addressed to the Editor,
28 West 126th Street, New York.
Address bulky mail matter to P. O. Box 1023, Nezv York.
This Journal is published in volumes of five issues each.
Single copies, 50 cents.
Original researches and other MSS. will be carefully considered,
and if found unsuitable will be returned, if accompanied by stamped,
self-addressed envelope.
";'?fi^^^?i^^;-'
PROFESSOR A. JOFFROY
I 844- I 908.
Dr. A. Joffroy, Professor of mental diseases at the Faculty of
Medicine, Paris, died suddenly November 24, 1908. His nu-
merous works on neurology and mental diseases are familiar to
the medical profession. As a scientist he belonged to the highest
ranks of workers. As a man he was democratic in manner and
showed professional hospitality to the numerous students who
came to him from all parts of the world. The neurologic and
psychiatric world has lost in him an excellent teacher, a hos-
pitable professor and an ardent worker.
Vol. VIII No. 2
The Journal of
Mental Pathology
Subscription Price: — $2.50 per volume. Single Copies, 50 cents
Edited by Louise G. Robinovitch, B. ^s L., M.D.
(Sbitorial Boarb
Dr. V. MAGNAN, Dr. A. JOFFROY, Dr. F. RAYMOND (Paris), Dr. CHAS. K.
MILLS (Phila.), Dr. G. MINGAZZINI, Dr. SANTE DE SANCTIS, Prof L.
LUCIANI (Rome), Dr. JUL MOREL (Belgium), Dr. E. REGIS (Bordeaux).
Contributors' Staff
BALLET, Prof. G. (Paris); BLEULER, Prof. E. (Zurich); BOURNEVILLE,
Ed, Progrh MSdical; CANNIEU, Prof. (Bordeaux) : CERLETTI, Dr. Ugo (Rome) ;
CHATTERJI, J. C. (Benares, India); CLAPAR DE, Ed, Arch, de Psychologie
(Switzerland); DAGONET, Dr. (France); DUCCESCHI, Dr. V. (Rome);
FABRIZI, Dr. G. (Rome); FAREZ, Dr. Paul; FERRI, Prof^ E. (Rome);
GIANNELLI, Dr. A. (Rome) ; GUIDI, Dr. G. (Rome) ; LOURIE, Ossip, Ph. D.
(Paris) ; MARIE, Dr. A. (France) ; MARRO, Dir. Annali di Freniatria (Italy) ;
MORSELLI, Prof. E. (Italy) ; PERUSINI, Dr. G. (Rome) ; PIERON, Dr. H. (Paris) ;
POLIMANTI, Dr. Osv. (Rome) ; RITTI, Dr. Ant., Ed. Annales Medico-Psychologiques ;
SEMIDALOW, Dr. B. (Moscow); SERGI, Prof. G.; SERGI, Dr. S. (Rome);
SERBSKI, Prof V. P. (Moscow) ; SOUKHANOFF, Dr. S. (Moscow) ; TOULOUSE,
Dr., Ed. Revue de Psychiatrie; TSCHISCH, Prof. W. (Russia); VURPAS, Dr. CI.
(France) ; VASCHIDE, N. (Paris).
STATE PRESS, Publishers,
NEW YORK, N. Y.
MSS. AND Communications should be Addressed to the Editor,
28 West I26th Street, New York.
TABLE OF CONTENTS.
LEADING ARTICLES.
Softening of the Genu Corporis Callosi, Dr. A. Giannelli. ... 49
Progressive Chronic Chorea. A Clinical and Anatomo-patho-
logical Study, Dr. R. Boniigli 6^,
Resuscitation of Electrocuted Animals, etc., Dr. Robinovitch 74
EDITORIAL.
What Paranoia is not. A Plea for an Intelligible Classification
of Mental Diseases 82
The "Simplified Expert Alienist" 87
International Congress of Psychiatry, Neurology and Psy-
chology 89
The XVIIth Congress of Alienists and Neurologists of France 89
The XVIth International Medical Congress 89
A New Journal of Psychiatry 89
BOOK REVIEWS.
Woman. A Treatise on the Normal and Pathological Emo-
tions, etc., Talmey 90
L/Hysterie et la Neurasthenic chez le Paysan, Terrien 90
I/Opera di Cesare Lombroso nella Scienza, etc 91
Text-Book of Psychiatry, etc., E. Mendel 92
Hampa Afro-Cubana. Los Negros Brujos. Apuntes para un
Estudio de Etnologia Criminale, Ferdinando Oritz 93
Neurologic, Psychiatric et Anthropologic Criminelle 94
A Text-Book of Mental Diseases, V. Serbski. 94
I Principi Fondamentale della Antropologia Criminale, etc. . . 94
Psychology applied to Medicine. Introductory Studies, W.
Wells 95
Cesare Lombroso. Appunti sulla Vita. Le Opere. Paola and
Gina Lombroso 95
Les therapeutiques recentes dans les maladies nerveuses. M.
Lannois 95
Ueber die Psychologie der Dementia Praecox, C. G. Jung. ... 96
Ueber Robert Schumanns Krankheit, P. J. Moebius 96
Ibsen's "Nora" vor dem Strafrichter und Psychiater, E.
Wulifen 96
Was sind Zwangsvorgaenge ? Bumke 96
Books and Pamphlets Received 3d cover
Vol. VIII _^ No. 3.
The Journal of
Mental Pathology
Subscription Price:— $2.50 per volume. Single Copies, 50 cents.
Edited by Louise G. Robinovitch, B. ^s L., M.D.
CEbitortal Boarb
Dr. V. MAGNAN, Dr. A. JOFFROY. Dr. F. RAYMOND (Paris), Dr. CHAS. K.
MILLS (Phila.), Dr. G. MINGA^ZINI, Dr. SANTE DE SANCTIS, Prof. L.
LUCIANI (Rome), Dr. JUL. MOREL (Belgium), Dr. E. REGIS (Bordeaux).
Contributors* Staff
BALLET, Prof. G. (Paris) ; BLEULER, Prof. E. (Zurich) ; BOURNEVILLE.
Ed. Progres Medical; CANNIEU, Prof. (Bordeaux): GERLETTI, Dr. Ugo (Rome);
CHATTERJI, J. C. (Benares, India); CLAPAREDE, Ed. Arch, de Psychologte
(Switzerland); DAGONET, Dr. (France); DUCCESCHI, Dr. V. (Rome);
FABRIZI, Dr. G. (Rome); FAREZ, Dr. Paul; FERRI, Prof. E. (Rome) ;
GIANNELLI, Dr. A. (Rome) ; GUIDI, Dr. G. (Rome); LOURIE, Ossip, Ph. D.
(Paris); MARIE, Dr. A. (France) ; MARRO, Uh\ Annali di Freniatria (Italy);
MORSELLI, Prof. E. (Italy) ; PERUSINI, Dr. G. (Rome) ; PIERON, Dr. H. (Paris) ;
POLIMANTI, Dr. Osv. (Rome) ; RITTI, Dr. Ant., Ed. Annales Medico-Psychologiques;
SEMIDALOW, Dr. B. (Moscow); SERGI, Prof. G.; SERGI, Dr. S. (Rome);
SERBSKI, Prof V. P. (Moscow); SOUKHANOFF, Dr. S. (Moscow); TOULOUSE,
Dr., Ed. Revue de Psychiatrie; TSCHISCH, Prof. W. (Russia) ; VURPAS, Dr. CI.
(France) ; VASCHIDE, N. (Paris).
STATE PRESS, Publishers,
NEW YORK, N. Y.
MSS. AND Communications should be Addressed to the Editor,
28 West I26th Street, New York.
TABLE OF CONTENTS.
LEADING ARTICLES.
The Development of the Modern Care and Treatment of the
Insane, as Illustrated by the State Hospital System of i
New York, Dr. Carlos F. MacDonald. 97
A New Method of Preserving the Central Nervous System
for Morphologic Study, Prof. A. Giannelli. . .......... 117
Peripheral Amyotrophy Due to Traumatism. Clinical and
Anatomopathological Study, Dr. R. Boniigli 121
A Case of Korsakoff's Psychosis Due to an Unusual Cause,
Dr. Serge Soukhanoff 126
Methods of Resuscitating Electrocuted Animals. Different
Effects of Various Electric Currents According to the
Method Used. Importance of Excluding from the Cir-
cuit the Central Nervous System During Resuscitation.
Second Preliminary Communica.tion, Dr. Robinovitch. . . 129
General and Cerebral Blood Pressure During an Attack of
Electric Epilepsy, Dr. Robinovich 136
Electric Anesthesia. Its Use in Laboratory Work, Dr.
Robinovich 138
Methods of Resuscitating Animals in a Condition of Respira-
tory and Cardiac Syncope Caused by Chloroform. Vari-
ous Electric Currents Used- Importance of Excluding
from the Circuit the Central Nervous System. Experi-
mental Study. A Preliminary Communication, Dr. Ro-
hinovitch ; 141
OBITUARY NOTICE.
Nicolas Vaschide 146
BOOK REVIEWS.
L'endemia gozzo-cretinica nelle famiglie, Drs. U. Cerletti and
G. Perusini 148
Legons cliniques sur Thysterie et Thypnotisme, Prof. Pitres. .149
Le Langage musical et ses troubles hysteriques^by Dr. In-
ge^nieros 149
Les ions et particulierement I'ion iode, Dr. Brillouet 150
Vol. VIII No 4.
The Journal of
Mental Pathology
1
Subscription Price, Single
r •
Edited by Louise G. Robinovitch, B. es L., M.D.,
(EMtorial Boarb
Dr. V. MAGNAN, Dr. R RAYMOND (Paris), Dr. CHAS. K. MILLS (Phila.);\ Dr.
G. MINGAZZINI, Dr. SANTE DE SANCTIS, Prof. L. LUCIANI (Rome), Dr. JV. L.
MOREL (Belgium), Dr. E. REGIS (Bordeaux).
Contributors' Staff
BALLET, Prof. G. (Paris) ; BLEULER, Prof. E. (Zurich) ; CERLETTI, Dr. Ugo
(Rome) ; CHATTERJI, J. C. (Benares, India) ; CLAPAREDE, Ed. Arch, de Psycholo-
gie (Switzerland); DAGONET, Dr. (France) ; DUCCESCHI, Dr. V. (Rome);
FABRIZI, Dr. G. (Rome) ; FAREZ, Dr. Paul; FERRI, Prof. E. (Rome);
GIANNELLI, Dr. A. (Rome); GUIDI, Dr. G. (Rome); MARIE, Dr. A. (France);
MARRO, Dir. Annali di Frematrm (Italy); MORSELLI, Prof. E. (Italy);
PERUSINI, Dr. G (Rome) ; PIERON, Dr, H. (Paris) ; RITTI, Dr. Ant., Ed. Annates
Medico-Psychologiques; SEMIDALOW, Dr. B. (Moscow); SERGI, Prof. G.; SERGI,
Dr. S. (Rome); SERBSKI, Prof. V. P. (Moscow); SOUKHANOFF, Dr. S. (St
Petersburg) ; TOULOUSE, Dr., Ed. Revue de Psychiatrie; VURPAS, Dr. CI. (France).
STATE PRESS, Publishers,
NEW YORK, N. Y.
MSS. AND Communications should be Addressed to the Editor,
28 West i26th Street^ New York.
i
/
r
TABLE OF CONTENTS.
LEADING ARTICLES.
Resuscitation of Subjects in a Condition of Apparent Death
Caused by Chloroform, Ether, Electrocution, Louise G.
Robinovitch ... .... . . . . ...,..;.... .153
Electric Anesthesia in Laboratory Surgery, Dr. Rohinovitch.i6g
Resuscitation of a Woman in Profound Syncope Caused by
Chronic Morphine Poisoning ; Rhythmic Excitations with
an Induction Current, Dr.. Robinovitch 179
Different Effects of Various Electric Currents. Choice of
Current for Resuscitation, Dr. Robinovitch 182
Presentation of Instruments : Motor-Interrupter Supplying a
Current of Frequent Interruptions for Electric Anesthe-
sia, Dr. Robinovitch 184
Induction ^^'*1 for Purposes of Resuscitation of Subjects in
a C; .^ition Oi i^i^^: ^nt Death Caused by Chloroform,
M^' jhine. Electrocution, Etc., Dr. Robinovitch 187
Jolyet's Cannula Modified by Dr. Robinovitch 189
A Tv/o-Cylinder Registering Apparatus, Professor Rouxeau's
\Model .■ .189
A Hand Signal, Dr. Robinovitch 190
A Portable Chronograph Giving Scale Traces, Dr. Robino-
vitch 191
Experimental Lesion of the Spinal Cord Produced by Means
of Lethal Electric Currents. Different Effects of Vari-
ous Electric Currents, Dr. Robinovitch 193
Triple Interrupter of Direct Currents. Portable Model for
Ambulance Service, Dr. Robinovitch 195
Induction Coil for Purposes of Resuscitation, Dr. Robino-
vitch 196
Physiologic Effects of a New Variety of Electric Currents,
Dr. Robinovitch 197
Professor A. Joffroy .200
BOOKS AND PAMPHLETS RECEIVED.
E. Wilhelm. — Die rechtliche Stellung der (koerperlichen)
Zwitter de lege lata und de lege ferenda.
F. W. Mott. — ^Morison Lectures, 1909. — The Pathology of
Syphilis of the Nervous System in the Light of Modern Re-
search.
Monographies cliniques : L. Bing. — ^Les injections mercuri-
elles intra musculaires dans le traitement de la syphilis.
A. Delille. — Le mecanisme de Timmunite. Anticorps, anti-
genes et deviation du complement.
Ch. Debierre. — L'heredite normale et pathologique.
TuM^r et Mar^m.— Traitement chirurgicale de la tubernilose
pulmonaire. Pneumectomie ; pneumotomie ; collapsthera^ \
methode de Freund.
L.
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